I. Loubinoux et al., SPREADING OF VASOGENIC EDEMA AND CYTOTOXIC EDEMA ASSESSED BY QUANTITATIVE DIFFUSION AND T2 MAGNETIC-RESONANCE-IMAGING, Stroke, 28(2), 1997, pp. 419-426
Background and Purpose The apparent diffusion coefficient (ADC) of wat
er should be sensitive to the cytotoxic edema triggered by energy fail
ure during ischemia. Elevated values of T2, the nuclear MR transverse
relaxation time of water, seen on T2 nuclear MR images detect vasogeni
c edema and infarcted areas. The temporal and spatial changes in ADC a
nd T2 abnormalities after occlusion of the middle cerebral artery (MCA
O) were therefore estimated by these two quantitative techniques. Meth
ods Permanent MCAO was performed on rats. Quantitative ADC and T2 maps
of brain water were obtained, from which the ischemic volumes were ca
lculated at various times up to 48 hours after MCAO. Results The areas
of decreased ADC represented 36+/-7% of the final infarct volume (24
hours) at 0.5 hours and 64+/-4% at 5 hours after MCAO, suggesting that
there is recruitment of peripheral areas with disturbed energy metabo
lism and cytotoxic edema. The ADC and T2 contours closely matched at 3
.5, 24, and 48 hours after MCAO. Conclusions T2 imaging can assess isc
hemic insults as well as ADC imaging, but only 3.5 hours after the ons
et of ischemia. Assessment of edematous swelling (approximate to 24.5%
of total infarcted volume) demonstrates that ADC and therefore T2 ima
ging detect all the tissue that will become infarcted approximately 7
hours after occlusion. The spread of ADC and T2 abnormalities would th
erefore stop at approximately 7 hours, and any further increase in vol
ume observed on the images would be mainly due to edematous swelling.