Lacunar Cerebral Infarct and Nuclear Magnetic Resonance

Abstract

A prospective series of 60 consecutive patients with lacunar cerebral infarcts (LI), studied using nuclear magnetic resonance (MR) and brain computerized tomography (CT), is presented. A significantly greater number of positive results (p < 0.001) was observed in the MR (78%) in comparison with the CT scan (30%). In pure motor hemiparesis, the number of positive results obtained with MR was maximal (85%) and greater than with CT scan (35%; p < 0.001). In pure sensory stroke, the positivity was 40% in MR and 20% in CT. In pontine and capsular topography, MR showed a greater sensitivity than CT scan (p < 0.001). A significantly (p < 0.001) greater number of silent infarcts were detected by MR (42%) than by CT scan (18.5%). Nowadays, MR is the complementary examination of choice in the topographic diagnosis of LI and should be carried out whenever possible in all patients presenting with this pathology.

Is Investigating for Carotid Artery Disease Warranted in Non-Cortical Lacunar Infarction?

“…47 However, evidence of cerebral infarction on CT scanning would be prevalent only in 61%, 48 and CT scanning has an even lower sensitivity for detecting lacunar infarction. 49 Although MRI is more sensitive at detecting lacunar infarcts, the use of MRI to differentiate lacunar from nonlacunar stroke would be substantially more expensive. On the other hand, the lack of radiological evidence of a cortical infarct on CT scan in a patient with clinical features of a lacunar stroke syndrome should be pragmatically sufficient to confirm the event to be a noncortical lacunar stroke.…”

What is the best imaging strategy for acute stroke?

“…As previously, the patient groups under investigation differed (some studies including more than one patient group): TIA (two studies, 41 patients), 203,228 lacunar stroke (five studies, 166 patients), 203,230,232,233,235 cerebellar stroke (one study 14 patients); 229 lateral medullary syndrome (one study, six patients) 231 and unselected stroke (four studies, 356 patients). 204,206,207,234 Again, studies were uniformly small.…”

“…204,206,207,234 Again, studies were uniformly small. Nine studies (75% of studies) collected data prospectively, 203,204,206,207,228,230,[233][234][235] while six studies (50%) blinded readers of scans either to clinical history 203,207,228,234,235 or to other imaging. 204 In only one study (0.8%) was the order in which CT or MR was performed varied (although not randomised); 207 two studies performed both scans on the same day but did not document the order in which they were done; 228,232 in five studies, CT was always performed before MR. 203,204,206,234,235 The extent of the difference in times varied: in one study where all patients were scanned within 24 hours, CT was performed a mean of 4 hours earlier, 234 in another study of imaging within the first 3 weeks of stroke, CT was performed a median of 4 days earlier, 203 and in three studies the order of scanning was not defined.…”

“…204 In only one study (0.8%) was the order in which CT or MR was performed varied (although not randomised); 207 two studies performed both scans on the same day but did not document the order in which they were done; 228,232 in five studies, CT was always performed before MR. 203,204,206,234,235 The extent of the difference in times varied: in one study where all patients were scanned within 24 hours, CT was performed a mean of 4 hours earlier, 234 in another study of imaging within the first 3 weeks of stroke, CT was performed a median of 4 days earlier, 203 and in three studies the order of scanning was not defined. 230,231,233 Details of excluded studies…”

“…The proportion of ischaemic lesions identified on scans ranged from 17 to 50% for CT and 78 to 94% for MR. 230,232,233,235 In one study, MR scans were performed 1-3 days after CT; 235 in the rest, the order of scanning was not defined.…”