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Value of diffusion-weighted imaging and apparent diffusion coefficient in recent cerebral infarctions: a correlative study with contrast-enhanced T1-weighted imaging.

BACKGROUND AND PURPOSE
The clinical usefulness and the time course of diffusion-weighted imaging and apparent diffusion coefficient (ADC) in acute and subacute cerebral infarction have not yet been established, although it is known that contrast-enhanced T1-weighted spin-echo imaging can detect a subacute infarct. Our aim was to study which imaging technique is useful in detecting recent infarcts, and whether an increase in ADC or a decrease in signal intensity on diffusion-weighted images is correlated with enhancement on T1-weighted spin-echo images.


METHODS
Forty-one infarctions with a duration of 9 hours to 27 days were studied in 29 patients. The ADC and signal intensity on diffusion-weighted images were compared with the contrast-enhancement ratio (CER) on T1-weighted spin-echo images (CER = signal intensity after contrast injection/signal intensity before contrast injection).


RESULTS
ADC was linearly correlated with CER, and signal intensity on diffusion-weighted images was inversely correlated with CER. The correlation between ADC and age of the infarct in the subacute phase was weak.


CONCLUSION
Diffusion-weighted and contrast-enhanced T1-weighted spin-echo images complement each other in detecting subacute infarcts. Neovascularization and disruption of the blood-brain barrier in infarcts can be important in increasing ADC in subacute infarcts.