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AJNR - American Journal of Neuroradiology

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Assessment of Diffusion and Perfusion Deficits in Patients with Small Subcortical Ischemia

Claudia A. Doege^a, Christian M. Kerskens^a, Berenice I. Romero^a, Peter Brunecker^a, Jan Junge-Hülsing^a, Wolfram von Pannwitz^a, Bianca Müller^a and Arno Villringer^a

^a From the Department of Neurology, Humboldt University, Charité, Berlin, Germany

View larger version (120K): [in a new window]   FIG 1. Patient 1. Whole lesion, as assessed by T2-weighted imaging at the third examination, 392 hours after the onset of symptoms. This demonstrates the typical lesion location in our patients, in all cases affecting the posterior limb of the internal capsule and the medial globus pallidus. In addition, the corona radiata is involved.

View larger version (48K): [in a new window]   FIG 2. CBF maps (top, relative CBF units, threshold 75% of contralateral side) and ADC maps (bottom) are given for patient 6 at 2 hours and 29 hours after symptom onset, respectively. Right, the corresponding T2-weighted image obtained at the final examination after 220 hours. The CBF lesion (arrow) increases in size from first to second examination. At both time points, the CBF lesion is smaller than the ADC lesion (arrow) and smaller than the final T2 lesion.

View larger version (42K): [in a new window]   FIG 3. A, ADC, CBF (relative CBF units, threshold 75% of contralateral side), MTT, and CBV maps 4 hours after onset of symptoms, for patient 1. None of the three different types of perfusion maps (MTT, CBF, CBV) showed any pathologic changes (on adjacent sections, however, small areas of altered perfusion were detected in this patient), whereas in the ADC map an ischemic area (arrow) was seen. B, ADC, CBF (relative CBF units, threshold 75% of contralateral side), MTT, and CBV maps 55 hours after onset of symptoms, for patient 1. The three different types of perfusion maps indicate an area of altered perfusion (arrows) smaller than the ADC lesion (arrow) at the same time point.

View larger version (16K): [in a new window]   FIG 4. Each column in this figure indicates the ratio (mean across all patients) of two lesion sizes. CBF lesion volumes are given at the threshold of 75%. The first and second columns (black) give the ratios CBF1 to ADC1 and CBF1 to T23. The CBF lesion at first examination is smaller than the ADC lesion at the same time point (P < .006, paired t test) as well as the final T2 lesion (P < .001, paired t test) as indicated by the ratio below unity. The third and fourth column (blue) give the ratios of the CBF lesion at the second time point to the ADC lesion at the same time point as well to the final T2 lesion. The ratio below unity indicates that the CBF lesion in the subacute phase is smaller than the ADC lesion at the same time point and the final T2 lesion (P < .001, P < .003, paired t test).