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[MR imaging of pontine infarction within 2 weeks after ictus]
Abstract:
Magnetic resonance (MR) images of 10 patients with pontine infarction were reviewed. A total of 17 examinations were performed on a 1.5 Tesla high-field scanner (GE) within two weeks after ictus. The infarcted area was detected by MR as early as 20 hours after stroke in one case. However, MR images obtained in two cases three and nine hours after onset were unremarkable. It is therefore suggested that follow-up study should be performed when initial MR images within 20 hours postictus are normal. T1-weighted images at four, nine and twelve days after ictus were interpreted as normal. In two of these three examinations, the infarcted areas were clearly demonstrated as hyperintense lesions on T2-weighted images. In the other examination, however, an area of mildly increased signal intensity was seen on T2-weighted images. This case suggests that the fogging effect is also observed on MR imaging and that a small pontine infarction may be overlooked during the subacute stage. Basilar artery occlusion was detected as an absence-of-flow void in three of the ten patients. In conclusion, MR imaging proved to be a relatively useful diagnostic modality for evaluating acute and subacute pontine infarctions.
Insights
Magnetic resonance (MR) imaging can detect pontine infarction early, but normal initial scans within 20 hours post-stroke warrant follow-up. T2-weighted images are crucial for identifying pontine infarcts, especially during the subacute stage.
Area of Science:
- Neuroradiology
- Neuroimaging
- Stroke Imaging
Context:
- Pontine infarction diagnosis relies on timely and accurate imaging.
- Magnetic resonance (MR) imaging is a key tool for evaluating acute and subacute neurological events.
- Early detection of pontine infarction is critical for patient management and outcomes.
Purpose:
- To evaluate the utility of magnetic resonance (MR) imaging in diagnosing pontine infarction.
- To determine the optimal timing and sequences for MR imaging detection of pontine infarcts.
- To assess the potential for missed diagnoses in the subacute stage due to imaging artifacts like the fogging effect.
Summary:
- MR imaging was performed on 10 patients with pontine infarction using a 1.5 Tesla scanner.
- Infarcted areas were detected as early as 20 hours post-stroke, but initial unremarkable scans within this timeframe necessitate follow-up.
- T2-weighted images effectively identified pontine infarcts, though the fogging effect can obscure findings in the subacute stage.
- Basilar artery occlusion was identified by the absence of flow voids in three patients.
Impact:
- MR imaging is a valuable tool for diagnosing acute and subacute pontine infarctions.
- The findings highlight the importance of follow-up MR studies when initial scans are normal within 20 hours post-ictus.
- Understanding the fogging effect on MR imaging can prevent overlooking small pontine infarcts during the subacute phase.