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[Subacute cerebral infarct: native and contrast medium-enhanced MRT]
H Henkes1, W Schörner, M Cordes
1Radiologische Klinik und Poliklinik, Klinikum Rudolf Virchow/Standort Charlottenburg, Freie Universität Berlin.
Abstract:
Twenty-five patients with clinical and CT findings indicating supratentorial cerebral infarct were prospectively studied with MR. MR examinations were performed between the 3rd and 150th day after stroke. T2-weighted axial images were compared with T1-weighted sequences after i.v. administration of Gd-DTPA. T2-weighted images demonstrated parenchymal lesions in all 25 patients. Postcontrast T1-weighted images, however, displayed pathologic contrast enhancement in only 19 areas of infarction. In 5 of the 25 patients, the use of Gd-DTPA provided additional diagnostic information by demonstrating gyral contrast enhancement as a pattern typical for ischemia. In 2 of the 25 patients, pathologic contrast enhancement was observed in an area that was isointense to the surrounding brain tissue on the T2-weighted images. In one patient, Gd-DTPA improved differentiation between areas of subacute and chronic infarction. At present, in the patient with suspected cerebral infarction, MR imaging after i.v. administration of Gd-DTPA appears recommended when clinical findings and CT are equivocal.
Insights
Gadolinium-enhanced Magnetic Resonance (MR) imaging aids in diagnosing cerebral infarction, especially when CT scans are inconclusive. Contrast-enhanced MR provides crucial details for identifying ischemic areas.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cerebral infarction diagnosis often relies on clinical presentation and CT scans.
- Magnetic Resonance (MR) imaging offers detailed anatomical visualization.
- The role of contrast agents in MR for stroke detection requires further clarification.
Purpose of the Study:
- To evaluate the diagnostic utility of MR imaging with Gadolinium-Diethylenetriaminepentaacetic acid (Gd-DTPA) contrast enhancement in patients with suspected supratentorial cerebral infarct.
- To compare T2-weighted MR sequences with postcontrast T1-weighted sequences in detecting and characterizing infarcts.
- To assess the added value of Gd-DTPA in differentiating infarct stages and identifying subtle lesions.
Main Methods:
- Prospective study of 25 patients with clinical and CT-confirmed supratentorial cerebral infarct.
- MR examinations performed between day 3 and 150 post-stroke.
- Comparison of T2-weighted axial images with T1-weighted sequences after intravenous Gd-DTPA administration.
Main Results:
- T2-weighted images detected parenchymal lesions in all 25 patients.
- Postcontrast T1-weighted images showed pathologic enhancement in 19 infarcts.
- Gd-DTPA provided additional diagnostic information in 5 patients, revealing typical ischemic gyral enhancement, and aided in differentiating infarct chronicity in one patient.
Conclusions:
- MR imaging with Gd-DTPA is recommended for suspected cerebral infarction when clinical findings and CT are equivocal.
- Contrast-enhanced MR can reveal infarcts not clearly depicted on non-contrast sequences.
- Gd-DTPA enhances the detection and characterization of ischemic lesions, improving diagnostic accuracy.