Imaging Diagnosis of Cerebral Ischemia

Abstract

The early diagnosis of patients with ischemic stroke is known to be important for both selecting the best therapy and for the patient's prognosis. Computed tomography is widely used as the first choice in detecting ischemic stroke and the early CT sign is used to diagnose super-acute cerebral infarction. However, it is reported that small infarctions and brain stem infarction of super-acute phase are difficult to diagnose by the early CT sign. From our experience, MRI can differentiate acute hematoma from acute infarction using DWI, and perfusion MRI is well correlated with perfusion sintigraphy by SPECT. We considered that MRI can be the first choice modality for acute ischemic stroke and useful to evaluate the existence of ischemic penumbra. Though MRI may be useful as the first choice modality for the patients with ischemic stroke, it is suggested that a more precise evaluation of ischemic penumbra is necessary and that a different technique such as MR spectroscopy should be evaluated on the basis of scientific evidence.