Abstract:
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Purpose: To investigate acute stage evolution of the watershed zone infarction on diffusion-weighted images and to evaluate the role of perfusion MR imaging.
Methods and Materials: We assessed acute stage infarct volume changes in 28 patients with watershed zone infarction on initial and follow-up (mean: 2.2 days) diffusion-weighted images during 2 years of period. Criteria for inclusion were based on the diffusion-weighted images and were having high signal lesions in the parasagittal cortex and deep white matter. In 20 patients, initial perfusion maps were obtained and compared with the infarct volume evolution.
Results: Infarct volume on initial and follow-up diffusion-weighted images were 8.7 ± 8.4 cc and 18.9 ± 27.4 cc, respectively. No case progressed to a large territorial infarction. In 21 cases, infarct volume did not change or only slightly increased, but less than 20 cc in final volume. In 3 cases, the final infarct volume increased moderately: 2 to 4 fold initial volume with less than 20 cc increment. The final infarct volume increased severely in 4 cases: more than 4 fold the initial volume with more than 20 cc increment. Among 20 cases in which perfusion maps were obtained, 8 cases showed perfusion-diffusion mismatch. In 3 cases stent was inserted in the occluded or stenotic internal carotid artery and infarct volume change was minimal. Remaining 5 cases were either not treated or treated but failed to obtain recanalization and among them, 4 cases developed severe progression. In 12 cases with matched perfusion-diffusion, infarct volume changed mildly, regardless of treatment
Conclusion: Watershed zone infarction usually begins as a small volume lesion and may increase slightly in acute stage, but dose not progress to a large territorial infarction. In cases with perfusion-diffusion mismatch, aggressive treatment should be provided whenever possible to avoid severe infarct progression.
Kim MD, S,
Acute Stage Evolution of Watershed Zone Infarction Assessed on Diffusion-Weighted MR Imaging. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3106641.html
