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Case - MR Perfusion Target Mismatch (Good Collaterals)

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These are images of a 62-year-old male

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who had right sided weakness.

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And initially, he had a non-contrast CT,

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and there's no hemorrhage.

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It looks pretty normal.

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Maybe there's some

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minimal, if any,

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abnormality in the left basal ganglia,

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and don't really see a hyperdense vessel sign.

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And then, he got a CTA.

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And you can see on the CTA that there's

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a cut off of this large M2 branch,

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and they're pretty good collaterals.

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So, that was the CTA.

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So next, he got an MR.

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And you can see on the DWI images

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that there's a very small infarct involving the left

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basal ganglia and corona radiata.

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And it's dark on ABC images,

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as you'd expect with an acute infarct.

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On the FLAIR images,

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there's really not much FLAIR abnormality

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because it's very early.

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There's no breakdown of blood-brain barrier,

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and then there's some hyperintensity in vessels

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all the way up over the cortex,

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suggesting that there's maybe good collateralization.

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So here's the DWI,

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and then this is the transit time map,

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the T max map that's thresholded,

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and you can see there's a big mismatch between

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the DWI and the delay in the transit time,

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which is basically most of the superior division

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of the left MCA.

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Som MCA, M2 embolus,

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big core penumbra mismatch,

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good collaterals.

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And so, this patient did go to thrombolysis.

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So, here's the follow up DWI.

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And you can see that here's the initial infarct,

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and there's a little bit of extension

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into the penumbra,

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but most of it was spared with the

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patient having thrombectomy.

Report

Faculty

Pamela W Schaefer, MD, FACR

Professor of Radiology, Vice Chair of Education

Massachusetts General Hospital

Tags

Vascular Imaging

Perfusion

Neuroradiology

Neuro

MRP

MRI

Head and Neck

CTA

CT

Brain

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