A Comparison of Fast Spin-Echo, Fluid-Attenuated Inversion-Recovery, and Diffusion-Weighted MR Imaging in the First 10 Days after Cerebral Infarction
Peter E. Ricci
,a,
Jonathan H. Burdettea,
Allen D. Elstera and
David M. Reboussina
a From the Departments of Radiology (P.E.R., J.H.B., A.D.E.) and Public Health Sciences (D.M.R.), Wake Forest University School of Medicine, Winston-Salem, NC.
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FIG 1. 74-year old patient scanned 14 hours after onset of vertigo.
A, FSE T2-weighted image reveals an old left cerebellar lacuna (arrow).
B, FLAIR image shows no cerebellar signal abnormality.
C, Diffusion-weighted image sensitive to water motion in the craniocaudal direction reveals an acute infarct in the right cerebellar hemisphere (arrow).
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FIG 2. 85-year old woman scanned on the second day after onset of right-sided limb weakness and vertigo.
A–C, Axial FSE image (A), coronal FLAIR image (B), and axial diffusion-weighted image sensitive to water motion in the craniocaudal direction (C) are normal.
D–F, Repeat study performed 24 hours later because of persistent symptoms reveals a pontine signal abnormality on FSE image (arrow, D), while FLAIR image (E) is still normal. Trace diffusion-weighted image shows a clear pontine infarct (arrow, F). In the repeat study, lesion conspicuity was rated superior on the diffusion-weighted image.
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FIG 3. 56-year old man scanned on day 2 after acute onset of vertigo and an intranuclear ophthalmoplegia, suggestive of a midbrain infarct.
A, FSE image reveals a tiny focus of abnormal signal in the right periaqueductal gray matter (arrow).
B and C, FLAIR image (B) and diffusion-weighted image sensitive to flow in the anteroposterior direction (C) are normal. The patient was discharged with a clinical diagnosis of a midbrain infarct and has not had follow-up imaging.
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FIG 4. 89-year old woman scanned 1 day after sudden onset of aphasia.
A–C, FSE (A), FLAIR (B), and trace diffusion-weighted (C) images all reveal abnormal signal in the left temporal lobe and insula (arrows). Conspicuity on the diffusion-weighted image was judged superior to that on the other two sequences.
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FIG 5. 79-year old man scanned 1 day after sudden onset of left arm and hand weakness.
A–C, FSE (A) and FLAIR (B, C) images reveal separate regions of signal abnormality consistent with acute infarction in the anterior (closed arrows) and posterior (open arrows) portions of the left frontal lobe. Conspicuity of both infarcts was judged to be superior on the FLAIR sequence.
D, Diffusion-weighted image sensitive to water motion in the transverse direction shows both infarctions better.
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FIG 6. 84-year old man scanned 2 days after sudden onset of limb weakness.
A–C, FSE (A) and FLAIR (B) images reveal a distinct right lateral medullary infarct (arrows). Conspicuity was judged superior on the FLAIR image. Although the trace diffusion-weighted image (C) also shows signal abnormality in the same location (arrow), conspicuity was judged inferior to that on both FSE and FLAIR images.
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