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Insights into Imaging
Fig. 2 | Insights into Imaging

Fig. 2

From: Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging

Fig. 2

a–f 52-years-old male with left MCA territory infarct. Initial DW images and their corresponding ADC maps at the basal ganglia level (a, a') and the supraganglionic level (b, b') reveal the presence of an acute infarction in I, M1, M2, M4 and M5 regions with a resultant ASPECTS score of 5. SW images at the basal ganglia level (c) and the supraganglionic level (d) reveal the presence of APVs, in terms of either density and/or caliber and/or hypointensity, in I (red arrow) and in M2, M3 and to a milder extent in M4 regions (purple, green, and white arrows respectively) with a resultant ASPECTS score of 6 (similar colored arrows point to the corresponding areas in the contralateral normal hemisphere for comparison). DWI/SWI mismatch score is − 1. Despite the overall negative mismatch, the presence of APVs in the M3 zone, which did not show an acute infarction in the initial DW images, indicates the presence of a hidden mismatch. However, follow up FLAIR images obtained 5 days later, at the basal ganglia level (e) and the supraganglionic level (f), reveal the presence of signal alteration in precisely the same zones that showed restriction in the initial DW images with no infarct progression

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