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Discrepancy between diffusion and perfusion imaging in a patient with transient ischaemic attack
C Ide1, B De Coene, J P Trigaux
1Service de Radiologie, Cliniques Universitaires de Mont-Godinne, Universite Catholique de Louvain, B-5530 Yvoir, Belgium. Christophe.Ide@rdgn.ucl.ac.be
Abstract:
We report paradoxical and ambiguous imaging findings in a patient with transient ischaemic attack (TIA). Perfusion-weighted (PW) MRI obtained 2 hours after symptoms onset showed a hypoperfused area in a region compatible with the focal deficit, while diffusion-weighted (DW) MRI was considered negative. Despite the complete resolution of the symptoms which had already begun at the end of the first MR examination, follow up DW MRI at 3 days showed partial conversion to hyperintensity of the initially hypoperfused area. This case illustrates that PW and DW MRI have to be used in combination and at different time points to correctly diagnose and manage ischaemic stroke because PW MRI is more sensitive than DW MRI for very early detection of ischaemia and delayed DW MRI provides the final signature of brain damage even in case of complete clinical recovering.
Insights
Transient Ischemic Attack (TIA) imaging can be ambiguous. Perfusion-weighted MRI detects early ischemia, while diffusion-weighted MRI confirms brain damage, even after symptom resolution.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Transient Ischemic Attack (TIA) diagnosis relies on timely and accurate imaging.
- Early detection of ischemic changes is crucial for patient management.
Observation:
- A patient presented with TIA symptoms and paradoxical MRI findings.
- Initial perfusion-weighted (PW) MRI showed hypoperfusion, but diffusion-weighted (DW) MRI was negative.
Findings:
- Symptoms resolved, but follow-up DW MRI revealed delayed hyperintensity in the hypoperfused area.
- PW MRI demonstrated higher sensitivity for early ischemia detection compared to initial DW MRI.
Implications:
- Combining PW and DW MRI at different time points improves ischemic stroke diagnosis.
- Delayed DW MRI is essential for confirming brain damage, irrespective of clinical recovery.