NMR-neuropathologic correlation in stroke

Abstract

True, three-dimensional proton nuclear magnetic resonance imaging at 0.147 tesla was performed postmortem on 2 patients embodying various stroke syndromes, including chronic (4 and 15 years) infarction, subacute (within 1 week) bland infarction, acute (2 days) hemorrhagic infarction, and hematoma secondary to ruptured aneurysm. A third patient, with subcortical arteriosclerotic encephalopathy, so-called Binswanger's disease, was examined antemortem using a 0.6 tesla scanner. Nuclear magnetic resonance images were reconstructed at levels matching the pathologic specimens. Qualitative and, when available, quantitative comparisons between the results of nuclear magnetic resonance imaging and pathology were carried out. Areas of qualitatively prolonged T1 and T2 relaxation times on nuclear magnetic resonance imaging were more extensive than the corresponding areas of chronic infarction noted pathologically and were determined to be infarcts plus the adjacent areas of Wallerian degeneration. Hemorrhagic infarction, without evidence of blood on computed tomography, was found to have mildly prolonged T1 and T2 relaxation times, between those of normal brain and chronic infarction; a 10-day-old hematoma had a very short T1, slightly shorter than that of white matter, and a mildly prolonged T2, with values between those of white and gray matter. Subcortical arteriosclerotic encephalopathy was found to have areas of prolonged T1 and T2 relaxation times involving almost the entire white matter of the corona radiata.