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MR diffusion imaging in stroke: review and controversies
N J Beauchamp1, A M Ulug, T J Passe
1Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Abstract:
Magnetic resonance (MR) diffusion imaging allows detection of cerebral ischemia within minutes of onset, and the temporal evolution of diffusion characteristics enables differentiation of acute from chronic stroke. T2-weighted MR imaging demonstrates infarcted tissue but fails to demonstrate acutely ischemic regions. Furthermore, the similar signal intensity characteristics of acute and chronic stroke on T2-weighted images limit the ability to determine the acuteness of an infarct. Diffusion imaging thus has tremendous potential for helping direct the treatment of acute ischemic stroke. Controversy exists over the pathophysiology of underlying changes in diffusion and the reversibility of changes after reperfusion in humans. There is also a lack of reproducibility in the time course of diffusion changes between research centers. Use of optimal diffusion imaging strategies results in increased conspicuity of ischemic regions and increased reproducibility of diffusion constants between research centers. An understanding of the principles of diffusion imaging and current controversies in the field is necessary for optimal application of this technique in the evaluation and treatment of cerebral ischemia.
Insights
Magnetic resonance diffusion imaging detects cerebral ischemia rapidly, distinguishing acute from chronic stroke. Optimizing diffusion imaging strategies enhances lesion visibility and reproducibility for better acute ischemic stroke treatment.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- T2-weighted MR imaging identifies infarcted tissue but not acute ischemia.
- Distinguishing acute from chronic stroke is challenging due to similar T2 signal intensities.
- Diffusion imaging offers potential for acute ischemic stroke treatment guidance.
Purpose of the Study:
- To highlight the potential of diffusion imaging in acute ischemic stroke.
- To address controversies regarding diffusion changes and reperfusion.
- To improve the reproducibility of diffusion imaging.
Main Methods:
- Utilizing magnetic resonance (MR) diffusion imaging.
- Analyzing the temporal evolution of diffusion characteristics.
- Employing optimal diffusion imaging strategies.
Main Results:
- Diffusion imaging detects cerebral ischemia within minutes.
- Optimal strategies improve ischemic region conspicuity and diffusion constant reproducibility.
- Current controversies exist regarding pathophysiology and reperfusion effects.
Conclusions:
- Diffusion imaging is crucial for evaluating and treating cerebral ischemia.
- Understanding diffusion imaging principles and controversies is vital for clinical application.
- Optimized diffusion imaging enhances diagnostic accuracy and treatment planning.