Purpose
To determine what kind of disease could be shown by noting the accentuated gray-white differentiation on the apparent diffusion coefficient (ADC) maps and whether there are different patterns of this finding according to etiology of brain damage.
Methods and Materials
Patients From December 2006 to Mar 2009, we prospectively collected MR images that showed accentuated gray-white differentiation on the ADC maps, and especially those ADC maps of those patients with hypoxic brain injury, brain death, hypoglycemia, status epilepticus and other toxic or metabolic encephalopathies and who were seen during our routine clinical practice. There were 19 patients (9 males and 10 females) with 20 MR images and their DWI or ADC maps showed pronounced gray-white differentiation. Their age ranged from 37 to 82 years (mean...
Results
Patterns of the diffusion-weighted images and the apparent diffusion coefficient mapsIn the patients with global brain injury, there were three different patterns of ADC decrease. We have defined these patterns, as a predominantly decreased ADC in the cerebral cortical area (pattern I), a decreased ADC in both the cerebral cortex and WM and a predominant decrease in the cerebral WM (pattern II), and a predominantly decreased ADC in only the cerebral WM (pattern III). Figure 1 show these patterns of the DWI and the ADC...
Conclusion
It is important for radiologists to recognize that accentuated gray-white differentiation suggests global brain injury. Pattern I is cerebral cortical injury, and this suggests cortical laminar necrosis in hypoxic brain injury. Pattern II is cerebral cortical and white matter injury, and this is frequently seen in brain death, while pattern III is mainly white matter injury and this is especially found in hypoglycemic brain injury.
References
1. McKinney AM, Teksam M, Felice R, et al. Diffusion-weighted imaging in the setting of diffuse cortical laminar necrosis and hypoxic-ischemic encephalopathy. AJNR Am J Neuroradiol 2004; 25:1659-1665.2. Arbelaez A, Castillo M, Mukherji SK. Diffusion-weighted MR imaging of global cerebral anoxia. AJNR Am J Neuroradiol 1999; 20:999-1007.3. Takahashi S, Higano S, Ishii K, et al. Hypoxic brain damage: cortical laminar necrosis and delayed changes in white matter at sequential MR imaging. Radiology 1993; 189:449-456.4. Chalela JA, Wolf RL, Maldjian JA, Kasner SE. MRI identification of...
Personal Information
Eunhee Kim M.D.1, Sung Tae KimM.D.1 , Dong Hoon Lee M.D21 Department of Radiology, Samsung Medical Center,50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea 135-7102Department of Radiology, Seoul Medical Center,171-1 Samsung-dong, Gangnam-gu, Seoul, Republic of Korea 135-740