Document Detail


CT sign of brain swelling without concomitant parenchymal hypoattenuation: comparison with diffusion- and perfusion-weighted MR imaging.
MedLine Citation:
PMID:  15860675     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To retrospectively evaluate the apparent diffusion coefficient (ADC) on magnetic resonance (MR) images and the perfusion parameters of lesions that show brain swelling without concomitant parenchymal hypoattenuation on computed tomographic (CT) scans. MATERIALS AND METHODS: Review board approval was obtained, and informed consent was waived. A total of 14 patients (seven men and seven women; mean age, 64 years +/- 11) were retrospectively selected from the consecutive 172 patients with acute cerebral ischemia who underwent CT within 6 hours of symptom onset. All patients had brain swelling without parenchymal hypoattenuation, including loss of gray-white matter distinction on CT scans, and they underwent diffusion- and perfusion-weighted MR imaging shortly after CT. CT attenuation, ADC, and perfusion parameters of relative cerebral blood volume (CBV), time to peak (TTP), and relative cerebral blood flow (CBF) were calculated for gray and white matter of the lesion. The measured values were compared with those of the contralateral hemisphere by using the paired t test; comparison of values of perfusion parameters among three subgroups was performed with the Kruskal-Wallis test. Arterial occlusions were determined with MR angiography or conventional angiography. RESULTS: The mean interval between initial CT and MR imaging was 2.4 hours +/- 0.9 (range, 0.4-3.4 hours). The ADC of lesions was similar to that of contralateral normal tissue (mean ADC ratio for gray matter and white matter, 0.99 and 0.97, respectively) (P > .05). Lesions had an increased relative CBV (P < .001), a mild to moderate TTP delay (P < .001), and a variable but not statistically significant reduction of relative CBF. The mean relative CBF of gray matter was less in patients who had complete infarction (0.81 +/- 0.16) than that in patients with partial infarction (0.99 +/- 0.16) or those with a normal radiologic outcome (1.12 +/- 0.22), but this difference was not statistically significant (P > .05). Proximal cerebral artery occlusions were found in all patients. In five (36%) patients, the lesion did not progress to infarction at follow-up. CONCLUSION: The CT sign of brain swelling without concomitant parenchymal hypoattenuation in patients with acute cerebral ischemia does not represent severe ischemic damage and may suggest ischemic penumbral or oligemic tissue.
Authors:
Dong Gyu Na; Eung Yeop Kim; Jae Wook Ryoo; Kwang Ho Lee; Hong Gee Roh; Sam Soo Kim; In Chan Song; Kee-Hyun Chang
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Publication Detail:
Type:  Journal Article     Date:  2005-04-28
Journal Detail:
Title:  Radiology     Volume:  235     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-05-25     Completed Date:  2005-06-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  992-48     Citation Subset:  AIM; IM    
Copyright Information:
Copyright RSNA, 2005.
Affiliation:
Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea. dgna@radiol.snu.ac.kr
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Brain Edema / pathology*,  radiography*
Cerebrovascular Circulation
Diffusion Magnetic Resonance Imaging*
Female
Humans
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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