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- Geijer, Bo, et al.
(författare)
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Persistent high signal on diffusion-weighted MRI in the late stages of small cortical and lacunar ischaemic lesions
- 2001
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Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 1432-1920 .- 0028-3940. ; 43:2, s. 115-122
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Tidskriftsartikel (refereegranskat)abstract
- Diffusion-weighted imaging (DWI) is very sensitive to early brain infarcts. However, the late stages have been insufficiently studied. Infarcts in small vessel disease are often multiple and of different ages, and differentiation between new and old lesions might be difficult. We have therefore studied the change with time in DWI of small (< 3 ml) ischaemic lesions. We imaged 21 patients with an acute lacunar syndrome and a lesion visible on early DWI. They all had three MRI examinations 12-58 h (early), 7-16 and 54-144 days after the onset of stroke; 10 patients with high DWI signal on the third examination had a fourth examination 12-28 months after the stroke. MRI was performed at 1.5 T, using echo-planar DWI with 7 b-values from 0 to 1200 x 10(6) s/m2 and conventional T2-weighted imaging. After 7-16 days 18 of 21 lesions gave high signal on DWI, and 12/16 measurable lesions had a decreased apparent diffusion coefficient (ADC). After 54-144 days ten lesions still gave high DWI signal and two still had an ADC below normal. On the fourth examination there was no remaining high DWI signal and all ADC were higher than normal.
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| 3. |
- Geijer, Bo, et al.
(författare)
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The value of b required to avoid T2 shine-through from old lucunar infarcts in diffusion-weighted imaging
- 2001
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Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 1432-1920 .- 0028-3940. ; 43:7, s. 511-517
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Tidskriftsartikel (refereegranskat)abstract
- Multiple small infarcts of different ages are common in small-vessel disease. Diffusion-weighted imaging (DWI) is a powerful method for discriminating new from chronic lesions. This can be done on the diffusion-weighted images provided that b is sufficiently high. Our purpose was to determine that critical value of b. We reviewed DWI from a previous study of acute, mainly lacunar strokes, and selected 18 old lacunar infarcts, well defined on uncoded images with b 0 s/m2 (i. e., T2-weighted images) but invisible on DWI with b 1,200 x 10(6) s/m2. We used a 1.5 tesla imager and single-shot echo-planar technique. We had seven separate acquisitions with echo time 123 ms and b in steps between 0 and 1,200 x 10(6) s/m2. Two neuroradiologists blinded to the selection of lesions carried out two different lesion-detection procedures, thereby testing each lesion four times, giving a total of 72 tests of b values. The results were consistent, indicating a level for detection of 800 x 10(6) s/m2 in two tests, 400-600 x 10(6) s/m2 in 65 tests and at lower values in the remainder. For imagers up to 1.5 tesla, at long repetition times and an echo time up to 120 ms T2-shine through of old lacunar infarcts can be avoided using b of 1,000 x 10(6) s/m2.
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| 4. |
- Sundgren, PC, et al.
(författare)
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Carotid artery stenosis: contrast-enhanced MR angiography with two different scan times compared with digital subtraction angiography
- 2002
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Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 1432-1920 .- 0028-3940. ; 44:7, s. 592-599
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Tidskriftsartikel (refereegranskat)abstract
- Contrast enhanced magnetic resonance angiography (CE MRA) is a non-invasive alternative to conventional digital subtraction angiography (DSA). CE MRA is increasingly used as a complement to Duplex in the preoperative assessment of carotid artery stenosis. The purpose of this study was to determine if CE MRA could replace preoperative DSA. CE MRA with a scan time of 10 or 28 s was performed in 24 consecutive patients who were scheduled for preoperative DSA because of Duplex-verified severe carotid artery stenosis. Two neuroradiologists measured the degree of stenosis with three different methods, and the image quality was evaluated. DSA was used as the gold standard. For detection of severe stenosis (N. American symptomatic carotid endarterectomy trial (NASCET) greater than or equal to70%; European symptomatic carotid endarterectomy trial (ECST) greater than or equal to80%; common carotid artery method (CCAM) greater than or equal to80%), the sensitivity of CE MRA maximum intensity projection (MIP) compared with DSA was 82%-100%, the specificity was 74%-93% and the accuracy was 77%-90%. The inter-observer agreement was higher, the image quality was better and the intracranial main arteries were better visualized with the 28 s than with the 10 s scan time. The enhancement of the jugular veins seen in 17% of the 10 s scans and in 58% of the patients with the 28 s scans did not interfere with the evaluation of the carotid arteries. CE MRA, preferably with a scan time of 28 s, can replace DSA in the preoperative assessment of most patients with carotid artery stenosis.
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