Multiple brain infarcts: Clinical and neuroimaging patterns using diffusion-weighted magnetic resonance

The capability of diffusion-weighted (DW) magnetic resonance imaging (MRI) to identify very early ischemic brain injury better than conventional MRI i s well known. This technique, which successfully discriminates acute from o ld infarcts, is particularly useful in patients with multiple brain infarct s (MBI). Among 142 patients with acute stroke consecutively admitted to our primary care center, we selected 43 patients with two or more brain infarc ts on conventional MRI. All patients presented with clinical deficits consi stent with acute cerebral ischemia and underwent conventional spin echo for T-1 (T1-WI) and T-2-weighted images (T2-WI), T1W gadolinium-enhanced image s, and echo-planar technique for DW MRI sequences. Patients underwent DW MR I examinations within 15 days of stroke onset (mean +/- SD: 3 +/- 3 days). In all but 1 case, the infarcts detected on DW MRI were also visible on T2- WI. The different signal pattern on DW MRI, compared with T2-WI, facilitate d the detection of acute infarcts in all patients. T1-WI with gadolinium en hancement was only helpful in 5 (11.6%) patients. DW MRI enabled precise cl inicotopographic correlations in 79% of our patients and provided additiona l clinically relevant findings in 72% of the patients. Based on the neurora diological findings, patients were divided into three clinicotopographic ty pes of MBI as follows: 13 patients (30.2%) presented with multiple acute in farcts, 24 patients (55.8%) with a single acute infarct and multiple old in farcts, and 6 patients (13.9%) with multiple acute and old infarcts. In con clusion, DW MRI can easily be added to conventional MRI in order to be able to distinguish acute from old infarcts, and to identify acute multiple les ions. Therefore, a better correlation between clinical symptoms and the sit e of lesions can be obtained, considerably improving patient care.