Cortical hyperintensity area on DWI depends on both residual CBF and time from the onset in acute cerebral ischemia.
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Recently, Diffusion weighted imaging (DWI) has been developed to detect early ischemic changes which could not be demonstrated by conventional MR imaging. It is unclear whether a hyperintensity area on DWI shows reversible or irreversible area. To define clinical significance of a hyperintensity area on DWI, we investigate the dependence of a hyperintensity area on both residual cerebral blood flow (CBF) and time from stroke onset.<BR>DWI (5 axial images) using 1.0 T MRI and residual CBF (2 axial images) using 133Xe-SPECT were performed in twenty-eight patients with acute cerebral embolic stroke. The time from stroke onset to DWI was 70-373 min. (mean value of 153.3 min). Cortical hyperintensity area within the middle cerebral artery (MCA) territory was observed in 16 cases (Group I) and not revealed in 12 cases (Group II). Mean CBF in cortical ischemic area within the MCA territory and focal CBF in cortical hyperintensity area within the MCA territory were calculated in each cases. Time from stroke onset to DWI was not significantly different between Group I and II, however, mean CBF in Group I and II (17.3±6.42 ml/100 g/min and 24.4±4.91 ml/100 g/min, respectively) was significantly different (p<0.05). In patients with cortical hyperintensity area, significant linear regression was observed between time (X time.) from stroke onset and focal CBF (Y ml/100 g/min) in cortical hyperintensity area on DWI (Y=0.052X+3.61, p<0.05). Residual CBF in cortical hyperintensity area after three hours from stroke onset was estimated as severe cerebral ischemia as CBF less than 13ml/100 g/min.<BR>These results suggest that cortical hyperintensity area on DWI depends on both residual CBF and time from stroke onset, and indicate irreversible ischemic area. Therefore, in patients with cortical hyperintensity area, thrombolytic therapy should not be considered to avoid hemorrhagic infarction in severe ischemic area.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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