Egelhof T, Essig M, von Kummer R, Dörfler A, Winter R, Sartor K
Abt. Neuroradiologie, Universität Heidelberg.
Rofo. 1998 Mar;168(3):222-7. doi: 10.1055/s-2007-1015117.
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.
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).
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.
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.
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