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STROKE ISKEMIK

MRI is more time consuming and less available than CT, but has significantly higher sensitivity and
specificity in the diagnosis of acute ischaemic infarction in the first few hours after onset.

diffusion weighted imaging (DWI) / ADC:


o

diffusion restriction may be seen within minutes following the onset of ischaemia

correlates well with infarct core

for detailed discussion of DWI and ADC in stroke see diffusion weighted MRI in
acute stroke

T2-weighted imaging and FLAIR:


o

less sensitive than DWI in the first few hours to parenchymal change

loss of normal signal void in large arteries may be visible immediately

after 6-12 hours infarcted tissue becomes high signal

sulcal effacement and mass effect develop and become maximal in the first few days

10

fogging: between 1-4 weeks (peak 2-3 weeks) infiltration of inflammatory cells may
reduce T2 signal such that it becomes relatively isointense to normal parenchyma.

T1
low intensity roughly mirrors high T2 / FLAIR signal

cortical laminar necrosis or pseudolaminar necrosis may be seen as a ribbon of


intrinsic high T1 signal, usually after 2 weeks (although it can be seen earlier) 10

T1 C+:
arterial enhancement (aka intravascular enhancement):

can be seen very early (0-2 hours) although it is more common at about

day 3

lasts approximately 1 week 10

seen in ~50% of cases


parenchymal enhancement:

usually begins towards the end of the first week 10


usually lasts less than 12 weeks; if longer than this the presence of an
underlying lesion should be considered 10
meningeal enhancement 10:

uncommon

seen in the first week, typically 1-3 days

usually fades by the start of the second week


GRE/SWI:

highly sensitive in the detection of haemorrhage

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