Cerebral Infarct/Intracranial Cerebrovascular Disease

P. Ellen Grant1, Pamela W. Schaefer1, R. Gilberto Gonzalez1

1 Massachusetts General Hospital, Boston, Massachusetts
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A1.1
DOI:  10.1002/0471142719.mia0101s14
Online Posting Date:  December, 2007
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Imaging goals for intracranial cerebral vascular disease are (1) to assess the degree of parenchymal injury and identify intraparenchymal hemorrhage; (2) to determine if there are areas of altered perfusion that may be at risk for future injury; and (3) to assess the intracranial arteries (patency as well as direction of flow). This unit describes a Basic Protocol that can be used to evaluate stable patients with acute, subacute, or chronic cerebrovascular symptoms. An Alternate Protocol is also given for cases of hyperacute strokes or cerebrovascular symptoms in an unstable patient.

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Table of Contents

  • Basic Protocol 1: Standard Imaging for Cerebral Infarct/Intracranial Cerebrovascular Disease
  • Alternate Protocol 1: Rapid Imaging for Acute Cerebral Infarct
  • Commentary
  • Literature Cited
  • Tables
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Basic Protocol 1: Standard Imaging for Cerebral Infarct/Intracranial Cerebrovascular Disease

  • Normal saline (0.9% NaCl), sterile
  • Gadolinium‐based MR contrast agent (e.g., Magnevist, Omniscan, or Prohance)
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Literature Cited

Literature Cited
   Boxerman, J.L., Hamberg, L.M., Rosen, B.R., and Weisskoff, R.M. 1995. MR contrast due to intravascular magnetic susceptibility perturbations. Magn. Reson. Med. 34:555‐566.
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   Burdette, J.H., Elster, A.D., and Ricci, P.E. 1999. Acute cerebral infarction: Quantification of spin‐density and T2 shine‐through phenomena on diffusion‐weighted MR images. Radiology 212:333‐339.
   Gonzalez, R.G., Schaefer, P.W., Buonanno, F.S., Schwamm, L.H., Budzik, R.F., Rordorf, G., Wang, B., Sorensen, A.G., and Koroshetz, W.J. 1999. Diffusion‐weighted MR imaging: Diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. Radiology 210:155‐162.
   Kucharczyk, J., Mintorovitch, J., Asgari, H.S., and Moseley, M. 1991. Diffusion/perfusion MR imaging of acute cerebral ischemia. Magn. Reson. Med. 19:311‐315.
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   Perl, J., 2nd, Tkach, J.A., Porras‐Jimenez, M., Lieber, M., Obuchowski, N., Ross, J.S., Ding, X.P., Ruggieri, P.M., Shearer, D.M., Khajavi, K., and Masaryk, T.J. 1999. Hemorrhage detected using MR imaging in the setting of acute stroke: An in vivo model. Am. J. Neuroradiol. 20:1863‐1870.
   Rordorf, G., Koroshetz, W.J., Copen, W.A., Cramer, S.C., Schaefer, P.W., Budzik, R.F. Jr., Schwamm, L.H., Buonanno, F., Sorensen, A.G., and Gonzalez, G. 1998. Regional ischemia and ischemic injury in patients with acute middle cerebral artery stroke as defined by early diffusion‐weighted and perfusion‐weighted MRI. Stroke 29:939‐943.
   Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott‐Raven, Philadelphia.
   Sorensen, A.G., Buonanno, F.S., Gonzalez, R.G., Schwamm, L.H., Lev, M.H., Huang‐Hellinger, F.R., Reese, T.G., Weisskoff, R.M., Davis, T.L., Suwanwela, N., Can, U., Moreira, J.A., Copen, W.A., Look, R.B., Finklestein, S.P., Rosen, B.R., and Koroshetz, W.J. 1996. Hyperacute stroke: Evaluation with combined multisection diffusion‐weighted and hemodynamically weighted echo‐planar MR imaging. Radiology 199:391‐401.
   Sorensen, A.G., Copen, W.A., Ostergaard, L., Buonanno, F.S., Gonzalez, R.G., Rordorf, G., Rosen, B.R., Schwamm, L.H., Weisskoff, R.M., and Koroshetz, W.J. 1999. Hyperacute stroke: Simultaneous measurement of relative cerebral blood volume, relative cerebral blood flow, and mean tissue transit time. Radiology 210:519‐527.
   Warach, S., Gaa, J., Siewert, B., Wielopolski, P., and Edelman, R.R. 1995. Acute human stroke studied by whole brain echo planar diffusion‐weighted magnetic resonance imaging. Ann. Neurol. 37:231‐241.
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