Stroke, Vol 17, 424-430, Copyright © 1986 by American Heart Association
U Ito, H Tomita, K Kito, Y Ueki and Y Inaba
To demonstrate the BBB break-down on the CT image in the acute stage of
cerebral infarction, a 3 hour continuous drip infusion of 200 ml of
meglumine amidotrizoate, rather than the conventional bolus injection, was
used. In this study, 22 examinations were carried out in 18 patients in
whom cerebral infarction due to temporary or permanent obstruction of the
cerebral artery was diagnosed by CT and angiography on admission. With each
examination, the first CT was obtained prior to contrast infusion, and
second immediately after the end of 3 hours of continuous contrast
infusion. The EMI number was calculated at 3 regions of interest in the
infarction. Within 3 days after stroke episode, 4 out of 5 patients with
temporary vascular obstruction demonstrated enhancement, as well as 6 out
of 9 patients with permanent vascular obstruction. Between 4 and 14 days
after the stroke episode, all of 8 patients showed enhancement. To further
clarify the extravasation of the contrast medium during the first 3 days of
a cerebral infarction, a third CT scan was performed 3-hrs after finishing
the contrast infusion in 4 patients. In these latter patients, blood was
sampled at the time of each of the 3 CT series. The EMI number of the blood
samples was also measured. In all 4 patients, the Gado's tissue-blood ratio
(the EMI number of the CT lesion divided by that of the blood sample) was
higher than 17.2% in the second, and higher than 54.7% in the third CT
scan. Thus break-down of the BBB which was demonstrated by prolonged
contrast infusion is an earlier event in human cerebral infarction than is
usually accepted.
ARTICLES
CT enhancement after prolonged high-dose contrast infusion in the early stage of cerebral infarction