Axial diffusion-weighted image (image 1) shows a region of r | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Axial diffusion-weighted image (image 1) shows a region of restricted diffusion corresponding to the vascular territory of the middle cerebral artery. The region is hypointense on T1-weighted imaging (arrow, image 2). On perfusion imaging (arrow, image 3), there is increased perfusion in the area of affected by the stroke consistent with luxury perfusion. Luxury perfusion is defined as "excessive brain blood flow in demand of the metabolic rate and oxygen demand of the brain tissue. It is nonnutritive flow to the infarcted tissue because of abnormal autoregulation system." It occurs after recanalization of a thrombosed artery and is thought to represent dysfunctional vascular autoregulation. #NeuroWednesday

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Axial CT (image 1) shows a parenchymal hemorrhage (arrow) within the right parietal lobe. Subsequent axial contrast-enhanced CT (image 2 and 3) show innumerable blood vessels within the right parietal lobe. Digital subtraction angiography (Image 4) highlights the vascular anomaly consistent with cerebral proliferative angiopathy. Cerebral proliferative angiopathy is a vascular lesion with diffuse intravascular shunting. It is differentiated from an arteriovenous malformation by normal intervening brain parenchyma.

  1. Which of the following is responsible for the bright signal in the left middle cerebral artery distribution on the diffusion-weighted image (part C)? A. Subacute hemorrhage B. Acute hemorrhage C. Vasogenic edema D. Cytotoxic edema
  2. What is the purpose of the apparent diffusion coefficient map (part D)? A. Corrects for T2 blackout effect B. Corrects for T2 shine-through C. Increases sensitivity for blood products D. Identifies brain tissue that is ischemic but not yet infarcted Question from Duke Review of MRI Physics: Case Review Series, 2nd edition, by Wells I. Mangrum. ISBN: 9780323530385. Copyright ©2019 Elsevier, Inc.

#Brain perfusion #SPECT and dynamic flow imaging demonstrating lack of tracer uptake or blood flow in the cerebrum, cerebellum and brain stem consistent with #Brain-death

CT perfusion. CBF. Brain #Stroke.

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