[Acute ischemic cerebral infarct: prospective serial observations by magnetic resonance imaging].
OBJECTIVE
Serial observations of acute ischaemic cerebral infarcts by MRI in order to define signal patterns, contrast uptake, oedema and secondary haemorrhage over a period of three months.


METHODS
Prospective serial examinations of 34 patients with acute cerebral ischaemia who were examined during the first 48 hours, on days 3 or 4, 7, 14, 21, 28 and after three months by MRI (spin echo TR/TE 2200/100/20, 500/20, +/- Gd).


RESULTS
T2 weighted spin echo sequences showed the highest sensitivity (88%) during the first 8 hours of cerebral ischaemia when compared with other spin echo sequences. Parenchymal contrast enhancement showed a distinct peak during the second and third weeks. The use of contrast did not improve diagnosis of an infarct during any stage. 87% of lesions showed haemorrhage at some stage. Vascular enhancement was observed in 25% of infarcts during the first 24 hours and was still present after three months in 20%. Parenchymal and vascular enhancement, and haemorrhage correlate with the size of the infarct.


CONCLUSIONS
Focal cerebral ischaemia produces an abnormality of the blood-brain barrier, oedema and finally necrosis, depending on the severity and duration of the lesion. Haemorrhage in 87% was considerably more common than has been described previously. Vascular enhancement is not an early sign of an infarct, contrary to what has been described in the literature.
Egelhof
T
T
Abt. Neuroradiologie, Universität Heidelberg.
Essig
M
M
von Kummer
R
R
Dörfler
A
A
Winter
R
R
Sartor
K
K
D000208:Acute Disease; D001812:Blood-Brain Barrier; D001921:Brain / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D017352:Echo-Planar Imaging / Q000379:methods*; D004487:Edema; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009336:Necrosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed