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Time Course of Cerebral Infarction in the Middle Cerebral Arterial Territory: Deep Watershed versus Territorial Subtypes on Diffusion-weighted MR Images¹

¹ From the Dept of Electrical Engineering, National Taiwan Univ, Taipei, Taiwan, Republic of China (I.J.H., H.W.C.); Depts of Radiology (I.J.H., C.Y.C., H.W.C., C.C.L., S.C.C.) and Neurology (D.C.C.), Tri-Service General Hosp and National Defense Med Center, 325, Section 2, Cheng-Kung Rd, Neihu 114, Taipei, Taiwan, Republic of China; and Institute of Statistics Science, Academia Sinica, Taipei, Taiwan, Republic of China (M.L.). Received Aug 18, 2000; revision requested Sep 26; revision received Jan 22, 2001; accepted Mar 2. I.J.H. and H.W.C. supported in part by grant NSC89-2213-E002-039 from the National Science Council. Address correspondence to C.Y.C. (e-mail: sandy0928@seed.net.tw).

PURPOSE: To examine possible differences between the evolution of cerebral watershed infarction (WI) and that of territorial thromboembolic infarction (TI) by using diffusion-weighted (DW) and T2-weighted magnetic resonance (MR) images and apparent diffusion coefficient (ADC) maps.

MATERIALS AND METHODS: Fourteen patients with TI and nine with WI underwent MR imaging from the acute to chronic infarction stages. ADC maps were derived from DW images. Lesion-to–normal tissue signal intensity ratios on ADC maps (rADC), echo-planar T2-weighted images, and DW images were calculated. Lesion volumes at acute or early subacute infarction stages were measured on DW images, and final lesion volumes were estimated on fluid-attenuated inversion-recovery images.

RESULTS: Analysis of variance revealed a significant difference in temporal evolution patterns of rADC between WI and TI (P < .001). rADC pseudonormalization following TI began about 10 days after symptom onset, but that following WI did not occur until about 1 month after symptom onset. The Pearson correlation coefficient between final and initial infarct volumes was 0.9899 for both infarction subtypes, indicating that the initial ischemic injury volume measured at the acute or early subacute stage predicted the final lesion volume fairly well.

CONCLUSION: The evolution time of ADC is faster for TI than for WI. This difference, which likely originates from the different pathophysiologic and hemodynamic features of the two infarction types, might account for the relatively large range of ADC values reported for the time course of ischemic strokes.

Index terms: Brain, infarction, 13.4352, 13.781 • Brain, MR, 13.121413, 13.121416, 13.12144 • Magnetic resonance (MR), diffusion study, 13.12144

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