허혈성 뇌경색에서 확산 강조 자기공명영상의 임상적 유용성

Abstract

Background and Objectives : Diffusion-weighted MRI(DWI) detects small changes in water diffusion in ischemic brain, and has advantages in early detection of ischemic lesions. However, the studies about DWI in subacute or chronic stages of stroke are scarce. The purpose of our study was to evaluate the clinical usefulness of DWI compared with T2WI in variable stages of ischemic stroke. Methods : Consecutive 179 DWIs in 171 patients(108 men and 63 women, age=62.2(¡¾10.6) with cerebral infarction were reviewed prospectively from July 1997 to June 1998. Stroke stages were classified as followings; hyperacute(<6 hours), acute(6 hours-4 days), subacute(4-10 days), and chronic(>10 days). We divided the patients into three groups according to infarct location and size; supratentorial(n=104), subcortical lacunar(n=36), and infratentorial(n=39). Results : DWI showed variable advantages over T2WI in 49% of total cases(100% in hyperacute stage, 55% in acute, 41% in subacute, 36% in even chronic). Of six false negative DWI cases in aucte or subacute stages, three were attributed to small medullary lesion. In one of them, brainstem multislice DWI could detect ischemic lesion. DWI showed additional usefulness to T2WI especially in supratentorial(53%) and lacunar stroke(56%) compared to infratentorial stroke(31%)(p<0.05). DWI detected additional ischemic lesions to T2WI in 39% of supratentorial infarction, and could discriminate acute from chronic infarcts in 53% of subcortical lacunar stroke. Conclusion:DWI showed variable advantages according to stroke stages and infarct location. In case of clinically diagnosed lower brainstem lesion, brainstem thin slice DWI sequence can enhance diagnostic sensitivity. Korean Journal of Stroke 1999;1(1):65~71