Dating ischemic stroke radiographics
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Diffusion-weighted MR imaging DWI is a technique used to assess the random Brownian motion of water molecules within a certain voxel of tissue. In other words, DWI is used to determine the ease of molecular diffusivity of water within a tissue. Many pathologies cause restricted extracellular diffusion of water protons including infarction, cytotoxic edema, high cellularity within tissue, viscous fluid, demyelination, and metabolic disturbances. Restricted diffusion is seen as high-signal intensity on DWI with corresponding reduced apparent diffusion coefficient ADC values. ADC is a measurement of the diffusion of water molecules in a given tissue. DWI is expressed with a b-value that is dependent on the characteristics of a sequence.
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Imaging of cerebral ischemic edema and neuronal death
CT has the advantage of being available 24 hours a day and is the gold standard for hemorrhage. Hemorrhage on MR images can be quite confusing. The reason we see ischemia on CT is that in ischemia cytotoxic edema develops as a result of failure of the ion-pumps.
Concept of Penumbra Once vascular supply to the brain has been compromised, there is a window of opportunity for reversing ischemic symptoms depending upon the level to which the blood flow has dropped. Ischemic brain tissue can functionally be divided into three components — infarct core, penumbra, and oligemic region Fig. When a cerebral artery is occluded, a core of brain tissue with severe perfusion deficit dies rapidly while the surrounding brain tissue ischemic penumbra with moderately reduced blood flow that may have lose electrical activity. Tissue in the penumbra may be salvageable with reperfusion; otherwise, the tissue in penumbra will progress to infarction.