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Postmortem MR imaging of lobar cerebral infarction with pathologic and in vivo correlation
M Castillo1, J H Scatliff, L Kwock
1Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA.
Abstract:
Postmortem magnetic resonance (MR) imaging features of different types of lobar cerebral infarction are correlated with the findings in gross and histologic specimens. The postmortem findings are also correlated with in vivo findings in similar cases selected from teaching files. In acute infarction, white matter vasogenic edema leads to high signal intensity on T2-weighted images and blurring of the gray-white matter junction. Petechial hemorrhage in the cortex results in inhomogeneous signal intensity on T2-weighted images. In laminar necrosis, the hyperintense cortex on T1-weighted images is due not to hemorrhage but possibly to necrosis and the presence of lipid-laden macrophages. In subacute infarction, cortical edema and necrosis may cause the gyral pattern of enhancement. Meningeal inflammation and early fibrosis are probably responsible for meningeal enhancement. In chronic infarction, gliosis and cystic malacia are responsible for the increased signal intensity of white matter on T2-weighted images. Knowledge of the pathologic features of cerebral infarction helps in understanding the MR imaging findings.
Insights
Postmortem MRI accurately identifies cerebral infarction types by correlating imaging with pathology. This aids in understanding acute, subacute, and chronic changes seen in brain imaging.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Cerebral infarction diagnosis relies on correlating imaging with pathological findings.
- Understanding postmortem magnetic resonance (MR) imaging features is crucial for interpreting in vivo studies.
Purpose of the Study:
- To correlate postmortem MR imaging findings of lobar cerebral infarction with gross and histologic specimens.
- To compare postmortem MR findings with in vivo findings in similar cases.
Main Methods:
- Postmortem MR imaging was performed on cerebral infarction specimens.
- Findings were correlated with gross pathology and histology.
- In vivo MR imaging from teaching files was used for comparison.
Main Results:
- Acute infarction shows T2 hyperintensity in white matter edema and cortical petechial hemorrhage.
- Laminar necrosis presents as T1 hyperintensity in the cortex, attributed to necrosis and macrophages.
- Subacute infarction may exhibit gyral enhancement due to edema and necrosis, with meningeal enhancement from inflammation/fibrosis.
- Chronic infarction demonstrates T2 hyperintensity in white matter due to gliosis and cystic malacia.
Conclusions:
- Postmortem MR imaging findings correlate well with pathological features of cerebral infarction.
- Understanding these correlations enhances the interpretation of both postmortem and in vivo MR imaging in cerebrovascular disease.
