(Stroke. 2000;31:1090.)
© 2000 American Heart Association, Inc.
Original Contributions |
Diffusion- and Perfusion-Weighted MRI Patterns in Borderzone Infarcts
From the Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center (C.J.C., G.S., L.R.C.), and the Stroke Division, Department of Neurology, New England Medical Center Hospital (J.D.), Boston, Mass; the Department of Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada (B.S.); and the National Institute of Neurological Disorders and Stroke, Stroke Branch (S.W.), Bethesda, Md.
Correspondence to Claudia J. Chaves, MD, Stroke Division, Dana 710, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115. E-mail cchaves{at}caregroup.harvard.edu
Background and Purpose—The pathophysiology of borderzone infarcts is not well understood. We investigated whether combined diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) could identify pathophysiologically meaningful categories of borderzone infarcts.
Methods—Seventeen patients with borderzone infarcts were identified from the Beth Israel Deaconess Medical Center Stroke Database. All patients had DWI and PWI, the majority of them within the first 24 hours of symptom onset.
Results—Three patterns of perfusion abnormalities were associated with the diffusion lesions: 1, normal perfusion (5 patients); 2, localized perfusion deficits matching the area of restricted diffusion (5 patients); and 3, extensive perfusion deficits involving 1 or more vascular territories (7 patients). All but 1 patient with pattern 1 had transient peri-infarct hypotension as the presumed stroke mechanism. Two patients with pattern 2 had cardiac or aortic embolic sources; none had large-artery disease or arterial hypotension. Reperfusion was detected in all patients with this pattern who submitted to a follow-up study. All patients with pattern 3 had severe stenosis or occlusion of a large artery: the internal carotid, anterior cerebral, or middle cerebral.
Conclusions—We postulate that the perfusion abnormality varies according to the mechanism of the borderzone infarction. Transient perfusion deficits occurring with hypotension in the absence of significant large-artery disease may not be revealed by PWI. Embolism may cause some cases of small borderzone perfusion deficits. Critical large-artery disease may cause large territorial perfusion deficits and predispose to borderzone infarction.
Key Words: cerebral infarction • magnetic resonance imaging, diffusion-weighted • magnetic resonance imaging, perfusion-weighted
This article has been cited by other articles:
 |
|
 |
|
  A. P. Kansagra and E. C. Wong Quantitative Assessment of Mixed Cerebral Vascular Territory Supply With Vessel Encoded Arterial Spin Labeling MRI Stroke, November 1, 2008; 39(11): 2980 - 2985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. Yong, O. Y. Bang, P. H. Lee, and W. Y. Li Internal and Cortical Border-Zone Infarction: Clinical and Diffusion-Weighted Imaging Features Stroke, March 1, 2006; 37(3): 841 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P H Lee, S H Oh, O Y Bang, I S Joo, and K Huh Pathogenesis of deep white matter medullary infarcts: a diffusion weighted magnetic resonance imaging study J. Neurol. Neurosurg. Psychiatry, December 1, 2005; 76(12): 1659 - 1663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Momjian-Mayor and J.-C. Baron The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease: Review of Cerebral Perfusion Studies Stroke, March 1, 2005; 36(3): 567 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Pedraza, Y. Silva, J. Mendez, L. Inaraja, J. Vera, J. Serena, and A. Davalos Comparison of Preperfusion and Postperfusion Magnetic Resonance Angiography in Acute Stroke Stroke, September 1, 2004; 35(9): 2105 - 2110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.-W. Kang, J. A. Chalela, M. A. Ezzeddine, and S. Warach Association of Ischemic Lesion Patterns on Early Diffusion-Weighted Imaging With TOAST Stroke Subtypes Arch Neurol, December 1, 2003; 60(12): 1730 - 1734. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Lee, O. Y. Bang, S. H. Oh, I. S. Joo, and K. Huh Subcortical White Matter Infarcts: Comparison of Superficial Perforating Artery and Internal Border-Zone Infarcts Using Diffusion-Weighted Magnetic Resonance Imaging Stroke, November 1, 2003; 34(11): 2630 - 2635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. C. Bisschops, C. J. M. Klijn, L. J. Kappelle, A. C. van Huffelen, and J. van der Grond Prevalence and Volume of Internal Border Zone Lesions in Patients With Impaired Cerebral Carbon Dioxide Vasomotor Reactivity: A Follow-up Study Arch Neurol, September 1, 2003; 60(9): 1233 - 1236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H.C. Bisschops, C. J.M. Klijn, L. J. Kappelle, A. C. van Huffelen, and J. van der Grond Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion Neurology, May 13, 2003; 60(9): 1435 - 1441. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Arakawa, K. Minematsu, T. Hirano, Y. Tanaka, Y. Hasegawa, K. Hayashida, and T. Yamaguchi Topographic Distribution of Misery Perfusion in Relation to Internal and Superficial Borderzones AJNR Am. J. Neuroradiol., March 1, 2003; 24(3): 427 - 435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Soeda, N. Sakai, H. Sakai, K. Iihara, N. Yamada, S. Imakita, and I. Nagata Thromboembolic Events Associated with Guglielmi Detachable Coil Embolization of Asymptomatic Cerebral Aneurysms: Evaluation of 66 Consecutive Cases with Use of Diffusion-Weighted MR Imaging AJNR Am. J. Neuroradiol., January 1, 2003; 24(1): 127 - 132. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. P. Derdeyn, A. Khosla, T. O. Videen, S. M. Fritsch, D. L. Carpenter, R. L. Grubb Jr, and W. J. Powers Severe Hemodynamic Impairment and Border Zone-Region Infarction Radiology, July 1, 2001; 220(1): 195 - 201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Szabo, R. Kern, A. Gass, J. Hirsch, and M. Hennerici Acute Stroke Patterns in Patients With Internal Carotid Artery Disease : A Diffusion-Weighted Magnetic Resonance Imaging Study Stroke, June 1, 2001; 32(6): 1323 - 1329. [Abstract] [Full Text] [PDF]
|
|