Neuro imaging Dr Teddy SpS
NEUROLOGIST VIEW
bull A brain CT or MRI scan is urgently recommended for all patients with suspected acute stroke or transient ischemic attack bull Noncontrast CT and gradient-recalled
echo MRI show similar accuracy in the diagnosis of acute intracerebral hemorrhage
bull Diffusion-weighted MRI is markedly more sensitive than noncontrast CT for distinguishing acute ischemic stroke from nonstroke conditions
bull Combined multimodal parenchymal perfusion and vascular imaging with CTor MRI could potentially identify patients with an ischemic penumbra that might be amenable to acute reperfusion therapies
bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention
bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming
bull CT is more readily available than MRI for emergency use
bull Equipment costs and patient charges are lower for CT than for MRI
bull CT involves exposure to ionizing radiation no known biological risk exists for MRI
bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke
bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be
screened to exclude unacceptable metal or electronics from the MRI scanning environment
bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI
bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
bull A brain CT or MRI scan is urgently recommended for all patients with suspected acute stroke or transient ischemic attack bull Noncontrast CT and gradient-recalled
echo MRI show similar accuracy in the diagnosis of acute intracerebral hemorrhage
bull Diffusion-weighted MRI is markedly more sensitive than noncontrast CT for distinguishing acute ischemic stroke from nonstroke conditions
bull Combined multimodal parenchymal perfusion and vascular imaging with CTor MRI could potentially identify patients with an ischemic penumbra that might be amenable to acute reperfusion therapies
bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention
bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming
bull CT is more readily available than MRI for emergency use
bull Equipment costs and patient charges are lower for CT than for MRI
bull CT involves exposure to ionizing radiation no known biological risk exists for MRI
bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke
bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be
screened to exclude unacceptable metal or electronics from the MRI scanning environment
bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI
bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
bull Diffusion-weighted MRI is markedly more sensitive than noncontrast CT for distinguishing acute ischemic stroke from nonstroke conditions
bull Combined multimodal parenchymal perfusion and vascular imaging with CTor MRI could potentially identify patients with an ischemic penumbra that might be amenable to acute reperfusion therapies
bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention
bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming
bull CT is more readily available than MRI for emergency use
bull Equipment costs and patient charges are lower for CT than for MRI
bull CT involves exposure to ionizing radiation no known biological risk exists for MRI
bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke
bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be
screened to exclude unacceptable metal or electronics from the MRI scanning environment
bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI
bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention
bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming
bull CT is more readily available than MRI for emergency use
bull Equipment costs and patient charges are lower for CT than for MRI
bull CT involves exposure to ionizing radiation no known biological risk exists for MRI
bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke
bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be
screened to exclude unacceptable metal or electronics from the MRI scanning environment
bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI
bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
bull CT is more readily available than MRI for emergency use
bull Equipment costs and patient charges are lower for CT than for MRI
bull CT involves exposure to ionizing radiation no known biological risk exists for MRI
bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke
bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be
screened to exclude unacceptable metal or electronics from the MRI scanning environment
bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI
bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be
screened to exclude unacceptable metal or electronics from the MRI scanning environment
bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI
bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Key words umur infark
Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada
kelainan setelah 6 jam infark
lt 4 haribull DWI Brightbull ADC darkbull Flair bright
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Umur infark 2
Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari
Infark kronik gt masa akutbull DWI darkbull ADC bright
Kebalikan infark akut
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-
cular thrombi
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Bila aspects score gt7 trombolyze
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
CT perfusi
bull Infark CBVbull Iskemi CBF dan MTT
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased
blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Perdarahan pada MRI
bull T2 dan Flair intensitas meningkat tidak homogen
bull GRE hitam
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are
suggestive of hemor- rhage
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Konfirmasi akut stroke
bull DWI putihbull ADC hitam
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Kronik infark
bull DWI hitambull ADC bright
Kebalikan dari infark akut
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal
lobe These features are suggestive of chronic infarction
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image
(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows
a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large
penumbra
Flow chart shows an acute stroke imaging protocolRadiographics october 2006
Flow chart shows an acute stroke imaging protocolRadiographics october 2006