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Related Experiment Videos

Reversed discrepancy between CT and diffusion-weighted MR imaging in acute ischemic stroke.

E Y Kim1, J W Ryoo, H G Roh

  • 1Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

AJNR. American Journal of Neuroradiology
|October 13, 2006
PubMed
Summary

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Early CT scans may miss some acute ischemic lesions, especially in the basal ganglia. These lesions, termed reversed discrepancy, often progress to infarction and may be underestimated by diffusion-weighted imaging (DWI).

Area of Science:

  • Neuroradiology
  • Cerebrovascular Diseases
  • Medical Imaging

Background:

  • Acute cerebral ischemia diagnosis relies on timely imaging.
  • Computed tomography (CT) and diffusion-weighted imaging (DWI) are crucial for detecting early ischemic changes.
  • Discrepancies between CT and DWI can impact treatment decisions.

Purpose of the Study:

  • To investigate the detectability of early CT ischemic lesions on DWI.
  • To define and characterize 'reversed discrepancy' (RD) in acute middle cerebral artery (MCA) infarction.
  • To assess the clinical significance of RD lesions.

Main Methods:

  • Retrospective analysis of CT and MR images from 70 acute MCA infarction patients within 6 hours of symptom onset.
  • Identification of reversed discrepancy (RD): parenchymal hypoattenuation on CT without hyperintensity on DWI.

Related Experiment Videos

  • Quantitative analysis of CT Hounsfield units (HU), apparent diffusion coefficients (ADCs), and perfusion parameters for RD lesions.
  • Main Results:

    • Reversed discrepancy (RD) was identified in 12.9% of patients, predominantly in the basal ganglia (89%).
    • RD lesions showed lower mean HU on CT and no significant decrease in ADC or cerebral blood flow.
    • Delayed DWI detected hyperintensity in 88.8% of RD lesions, all progressing to infarction; CT underestimated lesion extent compared to DWI in 66% of RD cases.

    Conclusions:

    • Early CT hypoattenuation indicating ischemia may be missed by DWI, particularly in the basal ganglia.
    • Reversed discrepancy (RD) lesions, though uncommon, invariably progress to infarction.
    • DWI may underestimate the true extent of severe ischemic tissue in acute MCA infarction.