MRI弥散加权对脑部病变的鉴别诊断.pptVIP

Imaging Tutorial: Differential Diagnosis of Bright Lesions on Diffusion-weighted MR Images High SI on DWI low ADC value Acute cerebral infarction: high sensitivity specificity Similar conditions: Cerebral hemorrhage --- tx problem Abscess Lymphoma Creutzfeldt-Jakob disease …… Acute Infarction CBF interruption ? rapid (within minutes) breakdown of energy metabolism and ion exchange pumps ? massive water shift from the extracellular into the intracellular (cytotoxic edema) ? restricted water diffusion (low ADC) ? typical bright spot on DWI Acute infarction within the 1st hour Acute infarction within the first 6 hours Acute Infarction Visible on DWI and ADC map within hours Within 6 hours: Sensitivity: 94~100% Specificity: 100% Acute Infarction DWI SI: Increase during 1st week Decrease thereafter Remain high SI for long period (up to 72 days): due to T2 shine-through Not deal for estimating lesion age ADC value: decline rapidly after onset of ischemia subsequently increase from dark to bright: 7-10 days later may differentiate: 10 days vs more acute ones ADC Values (x 10-3 mm2/sec) of Ischemic Lesions during Different Time Intervals DDx: Venous Stroke DDx: Cerebritis Venous Infarction: mechanisms(controversial) Retrograde venous pressure ? breakdown of BBB ? fluid leakage (vasogenic edema) completely reversible Tissue damage similar to arterial infarct (cytotoxic edema) The swollen cells might be functionally but not irreversibly damaged ? therefore have a potential for recovery Venous Infarction Still controversial Low SI on DWI: increased ADC value due to vasogenic edema High on DWI: decreased ADC value due to cytotoxic edema Cannot DDx from acute infarct Acute venous infarction with low SI on DWI and increased ADC values (left lateral sinus thrombosis) Acute venous infarction(SSS thrombosis) Tumors: Glioma DWI SI of gliomas is variable (hyper-, iso-, or hypointense) Tumor cellularity Hyperintense on DWI reduced ADC values due to reduced volume of e