Diffusion Weighted MRI Patterns Caused by Acute Border Zone Infarction

다국어 초록 (Multilingual Abstract)

Purpose: We investigated the causes and mechanisms driving acute border zone infarctions using diffusion-weighted imaging (DWI).
Materials and Methods: We analyzed DWI in 104 patients (male: 72 years, female: 32 years, age range: 44 to 84 years) with acute border zone infarction. The DWI patterns were classified as follows: pattern A- An acute border zone infarction combined with multiple small disseminated cortical infarctions, pattern B- An acute border zone infarction only.
Results: The most common cause of acute border zone infarctions was extracranial internal carotid artery (ICA) stenosis (45 cases, 43%). Other causes included middle cerebral artery stenosis (22 cases, 21%), intracranial ICA stenosis (14 cases, 13%), unknown, (12 cases 12%), iatrogenic (6 cases, 6%) and cardiogenic (5 cases, 5%), respectively. The most common pattern for DWI was pattern A (83 cases, 80%). We performed a transcranial Doppler in 7 of 75 cases (11%), and found at least 1 embolic pulse.
Conclusion: The most common pattern of DWI for acute border zone infarctions was pattern A. We propose that the mechanisms driving acute border zone infarctions are emboli coupled with hypoperfusion.

참고문헌 (Reference)

1 Bisschops RH, "van Huffelen AC, van der Grond J. Prevalence and volume of internal border zone lesions in patients with imapired cerebral carbon dioxide vasomotor reactivity : a follow-up study" 60 : 1233-1236, 2003

2 Momjian-Mayor I, "The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies" 36 : 567-577, 2005

3 Lee PH, "Subcortical white matter infarcts: comparison of superficial perforating artery and internal border-zone infarcts using diffusion-weighted magnetic resonance imaging" 34 : 2630-2635, 2003

4 Tsiskaridze A, "Stroke with interanal carotid artery stenosis" 58 : 605-609, 2001

5 Nakajima M, "Microembolic signals within 24 hours of stroke onset and diffusion-weighted MRI abnormalites" 23 : 282-288, 2007

6 Kimura K, "Microembolic signals and diffusion-weighted MR imaging abnormalities in acute ischemic stroke" 22 : 1037-1042, 2001

7 Belden JR, "Mechanisms and clinical features of posterior border-zone infarcts" 53 : 1312-1318, 1999

8 Lee DK, "Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease: early diffusion-weighted imaging study" 36 : 2583-2588, 2005

9 Yong SW, "Internal and cortical borderzone infarction: clinical and diffusion-weighted imaging features" 37 : 841-846, 2006

10 Wang KS, "Droste DW, et al. Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study" 52 : 74-81, 2002

11 Pollanen MS, "Directed embolization is an alternate cause of cerebral watershed infarction" 113 : 1139-1141, 1989

12 Chaves CJ, "Diffusion- and perfusion-weighted MRI patterns in borderzone infarcts" 31 : 1090-1096, 2000

13 Hennerici M, "Daffertshofer M, Jakobs L. Failure to identify cerebral infarct mechanisms from topography of vascular territory lesions" 19 : 1067-1074, 1988

14 Beal MF, "Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction" 31 : 860-865, 1981

15 Min WK, "Atherothrombotic middle cerebral artery territory infarction: topographic diversity with common occurrence of concomitant small cortical and subcortical infarcts" 31 : 2055-2061, 2000

16 Masuda J, "Atheromatous embolism in the brain: a clinicopathologic analysis of 15 autopsy cases" 44 : 1231-1237, 1994

17 Szabo K, "Acute stroke patterns in patients with internal carotid artery disease: a diffusionweighted magnetic resonance imaging study" 32 : 1323-1329, 2001