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Case - ASL Showing Tissue at Risk

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These are images of a 91-year-old female with

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left-sided weakness and you can see there's

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hypodensity in the right basal ganglia and

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going up into the corona radiata a little bit.

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MCA stem looks pretty good.

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I don't see an obvious hyperdense vessel sign.

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So, let's take a look at the CTA.

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So when we look at the CTA MIP, we can see

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that there is in fact an MCA cutoff.

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There's good collateralization in the right MCA territory.

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Not complete, though.

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It's not quite as good as the other side.

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So the patient then got perfusion

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images and diffusion images.

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And we can see on the diffusion map,

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that there's really just a small infarct

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involving the basal ganglia and the corona radiata.

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But here's the ASL image and you can see that

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there's a much larger area on

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the ASL compared to the DWI.

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So, it looks like there's a bit of tissue at

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risk and there's also, you'll notice this

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abnormality in the ACA territory as well.

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And then if you go back and look at the CTA,

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you can see there's a cutoff of one

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of the ACA branches right here.

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So, large area of tissue at risk.

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They maximize therapy,

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the patient had a follow-up CT.

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And you can see that this ACA territory

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did infarct and part of the MCA territory infarcted,

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but lower down, there was some sparing.

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So, just an example of ASL showing tissue at

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risk and progression of the infarct

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despite of maximum medical therapy.

Report

Faculty

Pamela W Schaefer, MD, FACR

Professor of Radiology, Vice Chair of Education

Massachusetts General Hospital

Tags

Vascular Imaging

Neuroradiology

Neuro

MRI

Head and Neck

CTA

CT

Brain

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