Magnetic Resonance Imaging with Diffusion and Perfusion in Assessment of Patients with Cerebral Infarction

Abstract

Background: Diffusion-weighted MR imaging is most useful for detecting irreversibly infarcted tissue, perfusion-weighted imaging may be used to identify areas of reversible ischemia as well. This work highlights the role of MR imaging in acute ischemic infarction evaluation, with particular emphasis on the importance of diffusion and perfusion MR imaging for evaluating the penumbra. Methods: This prospective study was conducted on 30 patients who were suspected to have a cerebral infarction. All patients underwent functional MRI. Results: 25 patients (83.3%) were isointense in T1 and only 5 patients (16.6%) were low intense, in T2 there was 25 patients (83.3%) were high intense and only 5 patients (16.6%) were isointense .in FLAIR there was 24 patients (80%) were high intense and only 6 patients (20%) were isointense. In DW1 all the cases show high signal also in ADC all the cases show low signal. As regards to Ischemic area: the mean rCBV (relative cerebral blood volume) in the core was 0.33±0.30 cc while in the peripheral area was 1.24±1.35 cc. There was a highly significant difference between CT and MRI in diagnosis of acute stroke with P= 0.001. Conclusion: Only depending on a single or a few parameters may not be sufficient, instead comprehensively combining the information from each MRI sequence (i.e., DWI, FLAIR and PWI) and using various mismatch parameters (DWI-FLAIR mismatch and/or PWI-DWI mismatch) may be more helpful in establishing an indication of MRI-based thrombolysis.