Identification of recent lacunar lesions in cases of multiple small infarctions by magnetic resonance imaging

In nine patients with recent lacunar stroke who revealed multiple small lesions in x-ray computed tomography (CT) and magnetic resonance imaging (MRI), CT and MRI enhancement studies were performed on the same day employing iodinated contrast medium and gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), respectively. In CT, the injection of contrast medium enhanced recent lesions in only four of the nine patients; furthermore, the effect was weak. In MRI, the injection of Gd-DTPA enhanced recent lesions in all patients except for one who was examined 4 weeks after ictus, and the effect was excellent. Recent infarcts could be identified only by Gd-DTPA-enhanced MRI in four of the nine patients. In patients with multiple small infarctions, identification of recent small infarcted lesions by CT or MRI is sometimes difficult; however, the use of Gd-DTPA in MRI makes it possible to distinguish recent infarcts from other lesions definitively.