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Imaging of Cerebral Infarct

Chen Xingrong; Shen Tianzhen (Department of Radiology, Huashan Hospital, Shanghai Medical University, Shanghai 200040)  
Cerebral infarct is defined as death of neurons and other brain cells caused by cerebral ischemia. Ischemic neuronal injury occurs through mechanisms directly related to the initial ischemic event. The cerebral ischemia can trigger a cascade of events leading to further neuronal cell death through amplification of a variety of secondary pathologic processes set in motion by ischemia. When the cerebral blood flow decreases to 15-20% of normal value, the dysfunction of Na~+ /K~+ - ATP ionic pump occurs. The failure to maintain ionic equilibrium results in a net flux of sodium and water from the extracellular space into the intracellular space, that is the so-called cytotoxic edema. The influx of sodium and water causes rapid phase of osmotic lysis or death of some neurons. When NMDA receptors are activated continueously, massive influx of calcium results in the activation of a series of related enzymes and overproduction of toxic free radicals, thus causes the delayed neuronal cells death. Imaging appearances in different stages of cerebral infarct: 1. Hyperacute infarct (6h): Routine CT and MRI usually are negative, but sometimes may show some subtle changes which are more obvious in acute infarct. MRI DWI appears as a high signal area. CT and MRI PCI presents as a low perfusion area. 2. Acute infarct (6 - 72h): Plain CT scan can show hyperdence brain artery sign, hypodense parenchymal sign and localized brain swelling sign. MRI TIWI and T2WI (including FLAIR) appear as low signal area and high signal area separately. After injection of Gd-DTPA vascular enhancement can be seen. The appearances of MRI DWI and PCI are similar to which showed in hyperacute infarct. 3. Subacute infarct (72h-10d): The findings of routine CT and MRI and MRI PWI are same as acute infarct. MRI DWI appears as low signal area. 4. Chronic infarct (11d): CT presents as a low density area. MRI TIWI and T2WI appear as low sighal area with a high signal rim which represents a zone of gliosis. MRI DWI shows a low signal area.
【CateGory Index】: R743.33
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