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Research ArticleBrain

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

Claudia A. Doege, Christian M. Kerskens, Berenice I. Romero, Peter Brunecker, Jan Junge-Hülsing, Wolfram von Pannwitz, Bianca Müller and Arno Villringer
American Journal of Neuroradiology August 2003, 24 (7) 1355-1363;
Claudia A. Doege
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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Christian M. Kerskens
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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Berenice I. Romero
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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Peter Brunecker
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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Jan Junge-Hülsing
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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Wolfram von Pannwitz
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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Bianca Müller
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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Arno Villringer
aFrom the Department of Neurology, Humboldt University, Charité, Berlin, Germany
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  • Fig 1.
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    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.

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    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.

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    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.

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    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).

Tables

  • Figures
  • Summary of lesion volumes for CBF (thresholds of 54.3% and 75%), ADC, and T2-weighted imaging

    Age/SexTime (h)CBF (54.3%)CBF (75%)ADCT2
    142/F462 ± 35116 ± 231914 ± 1211489 ± 140
    551055 ± 401461 ± 232562 ± 542734 ± 17
    392––426 ± 271929 ± 137
    266/F595 ± 32506 ± 321427 ± 92364 ± 51
    29162 ± 23603 ± 231756 ± 155842 ± 36
    321––1368 ± 1061910 ± 54
    376/F5158 ± 26169 ± 40510 ± 15205 ± 46
    22405 ± 40509 ± 401197 ± 176559 ± 37
    209––1364 ± 1592174 ± 96
    464/M3201 ± 35386 ± 35889 ± 151441 ± 52
    28348 ± 23542 ± 351616 ± 471678 ± 60
    148––2754 ± 1092987 ± 27
    560/M5518 ± 351105 ± 352564 ± 271118 ± 63
    24882 ± 231322 ± 233049 ± 232862 ± 41
    144––2645 ± 2363312 ± 27
    671/M2423 ± 231076 ± 352101 ± 75741 ± 54
    29896 ± 131686 ± 353288 ± 582877 ± 41
    220––2521 ± 274342 ± 44
    • Note.—Lesion volumes are given in mm3 (Mean ± SD from measurements by three independent observers).

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American Journal of Neuroradiology: 24 (7)
American Journal of Neuroradiology
Vol. 24, Issue 7
1 Aug 2003
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Cite this article
Claudia A. Doege, Christian M. Kerskens, Berenice I. Romero, Peter Brunecker, Jan Junge-Hülsing, Wolfram von Pannwitz, Bianca Müller, Arno Villringer
Assessment of Diffusion and Perfusion Deficits in Patients with Small Subcortical Ischemia
American Journal of Neuroradiology Aug 2003, 24 (7) 1355-1363;

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Assessment of Diffusion and Perfusion Deficits in Patients with Small Subcortical Ischemia
Claudia A. Doege, Christian M. Kerskens, Berenice I. Romero, Peter Brunecker, Jan Junge-Hülsing, Wolfram von Pannwitz, Bianca Müller, Arno Villringer
American Journal of Neuroradiology Aug 2003, 24 (7) 1355-1363;
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