Diffusion-Weighted MR Imaging of the Brain

by Moritani, Toshio; Ekholm, Sven; Westesson, P. L.

• ISBN13: 9783540034391
• ISBN10: 3540034390
• Edition: 1st
• Format: Hardcover
• Copyright: 2004-01-01
• Publisher: Springer Verlag

Summary

This practical-minded text helps the radiologist and the clinician understand diffusion-weighted MR imaging. The book's 14 chapters range from basic principles to interpretation of diffusion-weighted MR imaging and specific disease. It is aimed at all those who are involved in neuroimaging, including: residents, fellows, staff, as well as neurologists and neurosurgeons. Diffusion-weighted MR imaging is widely accepted as a means to identify acute infarction but also to differentiate many other pathologic conditions. Understanding diffusion-weighted imaging is important for radiologists, neurologists, neurosurgeons as well as radiology technologists. During the past four years, the expert authors have presented over 30 exhibits and scientific reports on diffusion-weighted imaging at the RSNA and the American Society of Neuroradiology (ASNR). More than 10 of these exhibits and presentations have been recognized by specific awards.

Table of Contents

Basics of Diffusion Measurements by MRI	1	(6)
Diffusion Imaging in MR	1	(1)
Diffusion Imaging of the Brain	1	(1)
Magnetic Resonance Principles of Diffusion Imaging	1	(1)
Apparent Diffusion Coefficient	2	(1)
Diffusion Represents a Molecular Event	3	(1)
Requirements in Clinical Diffusion Imaging	4	(1)
Setting the b-Value in Clinical DW Imaging	4	(1)
Future Trends in Clinical DW Imaging	5	(2)
References	5	(2)
Diffusion-Weighted Imaging of the Normal Brain	7	(4)
Introduction	7	(1)
Adult Brain	7	(2)
Low Signal in Basal Ganglia	7	(1)
Diffusion-Weighted Imaging of Gray and White Matter	7	(1)
Choroid Plexus	7	(2)
Pediatric Brain	9	(1)
Diffusion-Weighted Imaging and ADC of the Pediatric Brain	9	(1)
Conclusion	10	(1)
References	10	(1)
Pitfalls and Artifacts of DW Imaging	11	(14)
Introduction	11	(1)
Influence of ADC and T2 on the DW Appearance	11	(1)
Concepts	11	(1)
Apparent Diffusion Coefficient Maps	11	(1)
Exponential Images	11	(1)
Clinical Conditions	12	(6)
T2 Shine-through	12	(3)
T2 Washout	15	(1)
T2 Blackout	16	(2)
Artifacts	18	(5)
Eddy Current Artifacts	18	(1)
Susceptibility Artifacts	18	(2)
N/2 Ghosting Artifact (Nyquist Ghost)	20	(1)
Chemical Shift	20	(1)
Motion Artifacts	20	(3)
Conclusion	23	(2)
References	23	(2)
Brain Edema	25	(14)
Characterization and Classification of Brain Edema	25	(1)
Definition and Classification of Cytotoxic Edema	25	(1)
Pathophysiology of Cytotoxic Edema	25	(3)
Energy Failure	25	(2)
Excitotoxic Brain Injury	27	(1)
Diffusion-Weighted Imaging and Cytotoxic Edema	28	(7)
Conditions that Cause Cytotoxic Edema, and Reversibility	29	(6)
Vasogenic or Interstitial Edema	35	(2)
Conditions that Cause Vasogenic Edema	36	(1)
Conclusion	37	(2)
Cytotoxic or Cellular Edema	37	(1)
Vasogenic Edema	37	(1)
References	37	(2)
Infarction	39	(16)
Clinical Significance and Therapeutic Considerations for Brain Infarcts	39	(1)
Stroke Mimickers	39	(1)
Diffusion-Weighted Imaging	39	(1)
Diffusion-Weighted Imaging and Pathophysiology of Cerebral Infarction	39	(1)
Apparent Diffusion Coefficient	40	(1)
Explanation for Restricted Diffusion	40	(1)
Time Course of Infarction	40	(5)
Hyperacute (<6 Hours)	40	(2)
Acute (6 Hours to 3 Days)	42	(1)
Subacute (3 Days to 3 Weeks)	43	(1)
Chronic (3 Weeks to 3 Months)	44	(1)
Diffusion-Weighted Imaging and ADC Characteristics of Gray and White Matter Ischemia	45	(1)
Relative ADC	45	(1)
Reversibility and Treatment	45	(2)
Watershed Infarction	47	(1)
Perfusion Versus Diffusion Imaging	48	(1)
Venous Infarction	48	(2)
Predisposing Factors	48	(1)
Pathophysiology	48	(2)
Small Vessel Infarcts	50	(1)
Brain Stem and Cerebellar Infarcts	51	(1)
Corpus Callosum Infarcts	52	(1)
Hemorrhagic Infarcts	53	(2)
References	54	(1)
Intracranial Hemorrhage	55	(18)
Introduction	55	(1)
Intraparenchymal Hemorrhages: Appearance and Evolution	55	(7)
Hyperacute Hematoma	55	(4)
Acute Hematoma	59	(1)
Early Subacute Hematoma	59	(3)
Late Subacute Hematomas	62	(1)
Chronic Hematomas	62	(1)
Subarachnoid Hemorrhage	62	(2)
Subdural and Epidural Hemorrhages	64	(1)
Intraventricular Hemorrhage	65	(1)
Intra-tumoral Hemorrhage	66	(1)
Hemorrhage Related to Vascular Malformation	67	(1)
Hemorrhage Related to Trauma	68	(1)
Conclusions	68	(5)
References	69	(4)
Vasculopathy and Vasculitis	73	(22)
Definition	73	(1)
Clinical Presentation	73	(1)
Treatment	73	(1)
Vasculitis of the CNS	73	(11)
Characterization of CNS Vasculitis	73	(1)
Primary Angitis of the Central Nervous System	74	(1)
Giant Cell (Temporal) Arteritis	75	(3)
Takayasu's Arteritis (Aortitis Syndrome)	78	(2)
Polyarteritis Nodosa	80	(1)
Churg-Strauss Disease	80	(1)
Other Small Vessel Vasculitis	80	(1)
Collagen Vascular Diseases	80	(2)
Infectious Vasculitis	82	(1)
Drug-Induced Vasculitis, Including Illicit Drugs	83	(1)
Vasculopathy of the CNS	84	(8)
Systemic Lupus Erythematosus	84	(2)
Moyamoya Disease	86	(1)
Sickle Cell Disease	86	(1)
Posterior Reversible Encephalopathy Syndrome	86	(1)
Hypertensive Encephalopathy	87	(1)
Preeclampsia/Eclampsia	88	(1)
Immunosuppressive Drug-Induced Vasculopathy	89	(2)
Uremic Encephalopathy and Hemolytic Uremic Syndrome	91	(1)
Thrombotic Thrombocytopenic Purpura	92	(1)
Cerebral Amyloid Angiopathy	92	(1)
Conclusion	92	(3)
References	93	(2)
Epilepsy	95	(12)
Definition	95	(1)
Classification	95	(1)
Mechanisms and Pathophysiology of Epilepsy	95	(1)
Magnetic Resonance Imaging of Epilepsy	96	(7)
Diffusion-Weighted Imaging in Epilepsy	97	(1)
Magnetic Resonance Signal Alterations in Epilepsy	98	(1)
Ictal Stage to Periictal Stage	99	(1)
Status Epilepticus	100	(1)
Cytotoxic Edema in Status Epilepticus	101	(2)
Other Imaging Techniques for Epilepsy	103	(1)
Hemiconvulsion-Hemiplegia Epilepsy Syndrome	103	(1)
Focal Lesion in the Splenium of the Corpus Callosum in Epileptic Patients	103	(1)
Conclusion	103	(4)
References	105	(2)
Demyelinating and Degenerative Disease	107	(12)
Demyelinating Disease	107	(6)
Multiple Sclerosis	107	(5)
Acute Disseminated Encephalomyelitis	112	(1)
Progressive Multifocal Leukoencephalopathy	112	(1)
Degenerative Disease	113	(3)
Wallerian or Transneuronal Degeneration	113	(1)
Creutzfeldt-Jakob Disease	114	(2)
Amyotrophic Lateral Sclerosis	116	(1)
Conclusion	116	(3)
References	117	(2)
Toxic and Metabolic Disease	119	(12)
Toxic Disease	119	(6)
Chemotherapy-Induced Leukoencephalopathy	119	(1)
Heroin-Induced Spongiform Leukoencephalopathy	119	(1)
Cocaine, Phencyclidine Hydrochloride, Amphetamines and Related Catecholaminergics	119	(3)
Central Pontine Myelinolysis and Extrapontine Myelinolysis	122	(1)
Wernicke Encephalopathy	123	(1)
Marchiafava--Bignami Disease	124	(1)
Metabolic Disease	125	(6)
Mitochondrial Encephalopathy	125	(1)
Phenylketonuria	126	(1)
Other Metabolic Diseases and Leukodystrophies	126	(3)
References	129	(2)
Infectious Diseases	131	(18)
Overview of Brain Infections	131	(1)
Bacterial Brain Abscess	131	(1)
Septic Emboli	132	(1)
Brain Abscess Caused by Unusual Bacteria	133	(4)
Differential Diagnosis	133	(4)
Bacterial Abscess in the Extra-Axial Space	137	(4)
Differential Diagnosis	137	(4)
Bacterial Vasculitis	141	(1)
Toxoplasmosis	141	(4)
Differential Diagnosis	143	(2)
Disseminated Aspergillosis	145	(1)
Herpes Encephalitis	145	(1)
Human Immunodeficiency Virus Infection	146	(3)
References	147	(2)
Trauma	149	(12)
Introduction	149	(1)
Diffuse Axonal Injury	149	(5)
Location	149	(5)
Computed Tomography and MR Imaging	154	(1)
Diffusion-Weighted Imaging	154	(1)
Brain Contusion	154	(2)
Location	154	(2)
Computed Tomography and MR Imaging	156	(1)
Diffusion-Weighted Imaging Findings	156	(1)
Hemorrhage Related to Trauma	156	(3)
Computed Tomography and MR Imaging	157	(1)
Diffusion-Weighted Imaging	157	(2)
Vascular Injuries	159	(2)
References	160	(1)
Brain Neoplasms	161	(20)
Introduction	161	(1)
Gliomas	161	(8)
High-Grade Tumors	161	(7)
Peritumoral Infiltration	168	(1)
Treatment Response	168	(1)
Epidermoid Tumors and Arachnoid Cysts	169	(2)
Primitive Neuroectodermal Tumors	171	(1)
Meningiomas	172	(2)
Malignant Lymphomas	174	(1)
Craniopharyngiomas	175	(1)
Metastases	176	(2)
Conclusion	178	(3)
References	178	(3)
Pediatrics	181	(20)
Water Content of the Pediatric Brain	181	(1)
Normal Structures	181	(1)
Anisotropy	182	(1)
Infarction and Ischemia	182	(4)
Moyamoya Disease	184	(1)
Sickle Cell Disease	184	(1)
Hypoxic Ischemic Encephalopathy	184	(2)
Trauma	186	(3)
Battered Child Syndrome	186	(3)
Diffuse Axonal Injury and Brain Contusion	189	(1)
Encephalopathies	189	(2)
Mitochondrial Encephalopathy	189	(1)
Acute Necrotizing Encephalopathy	190	(1)
Hypertensive Encephalopathy	190	(1)
Infections	191	(3)
Encephalitis	191	(2)
Brain Abscess	193	(1)
Brain Tumor	194	(1)
Dysmyelination and Demyelination	195	(4)
Pelizaeus-Merzbacher Disease	195	(1)
Vanishing White Matter Disease	196	(1)
Metabolic or Toxic Leukoencephalopathies	196	(1)
Multiple Sclerosis	197	(1)
Osmotic Myelinolysis	197	(2)
Conclusion	199	(2)
References	199	(2)
How to Use This Book	201	(24)
Table 1 Differential diagnoses for lesions with a high diffusion signal associated with low ADC and iso intense T2 signal	202	(1)
Table 2 Differential diagnoses for lesions with a high diffusion signal associated with iso-high ADC and a high intense T2 signal	203	(5)
Table 3 Differential diagnoses for lesions with a high diffusion signal associated with a low ADC and high intense T2 signal	208	(10)
Table 4 Differential diagnoses for lesions with an iso diffusion signal associated with a high ADC and high intense T2 signal	218	(1)
Table 5 Differential diagnoses for lesions with a low diffusion signal associated with a high ADC and high intense T2 signal	219	(2)
Table 6 Differential diagnoses for lesions with a low diffusion signal associated with a high ADC and iso intense T2 signal	221	(1)
Table 7 Differential diagnoses for lesions with artifacts	222	(3)
Subject Index	225