Gyriform restricted diffusion in adults: looking beyond thrombo-occlusions.

Area of Science:

• Neuroradiology
• Neuroimaging
• Neurology

Background:

• Gyriform restricted diffusion (GRD) on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) sequences indicates cytotoxic edema.
• While commonly associated with acute ischemic stroke due to vascular occlusion, GRD can manifest in various non-vascular neurological conditions.

Purpose of the Study:

• To review and illustrate less common, non-stroke etiologies of gyriform restricted diffusion in adult patients.
• To provide a pattern-based reference for differentiating non-stroke GRD from ischemic stroke on neuroimaging.

Main Methods:

• Literature review focusing on non-stroke causes of GRD.
• Case-based examples illustrating diverse etiologies of GRD.
• Creation of a tabulated chart summarizing patterns of cortical and subcortical involvement.

Main Results:

• Gyriform restricted diffusion can be caused by various conditions beyond vascular occlusion, including metabolic, toxic, infectious, and inflammatory etiologies.
• Distinct patterns of cortical and subcortical involvement aid in differentiating these non-stroke causes from ischemic stroke.
• Case examples demonstrate the varied appearances of GRD in different neurological contexts.

Conclusions:

• Recognizing non-stroke causes of GRD is crucial for accurate diagnosis and appropriate clinical management.
• Utilizing pattern recognition in neuroimaging can help differentiate GRD secondary to stroke from other neurological conditions.
• This review provides a valuable resource for radiologists in daily reporting of GRD findings.