Diffusion Tensor Imaging for the Differentiation of Microangiopathy, Infarction and Perfusion-Diffusion Mismatch Lesions

Purpose: This study was designed to evaluate the usefulness of diffusion tensor imaging (DTI) and the DTI indices for differentiating between microangiopathy lesions, acute infarction lesions and perfusion-diffusion mismatch areas. Materials and Methods: DTI was performed in 35 patients with the use of a 1.5 Tesla MRI system. The MRI parameters were as follows: a spin echo EPI sequence with a bvalue = 1000 s/mm 2 , 25 diffusion directions, a repetition time of 8400 msec, an echo time of 75 msec, a matrix size of 128 128, a FOV of 22 cm and a 4 mm slice thickness. From the diffusion tensor images, the apparent diffusion coefficient (ADC), fractional anisotropy (FA), volume ratio (VR), relative anisotropy (RA), anisotropy index (AI), exponential ADC (eADC) and magnitude diffusion coefficient (MDC) were measured for the contra-lateral normal area (28 cases), the microangiopathy lesions (10 cases), the infarction lesions (17 cases) and the perfusion-diffusion mismatch area (8 cases). Results: As compared to the normal area, the microangiopathy lesions showed increased ADC and MDC values and decreased FA, VR, RA, AI and eADC values. The infarction lesions showed increased VR, RA and eADC values, a normal FA, a decreased AI and decreased ADC and MDC values. The mismatch area showed a similar pattern as that for the microangiopathy lesions; however, the differences were not prominent, with an increase of the ADC and MDC values and a decrease of FA, VR, RA, AI and eADC values. Conclusion: The DTI indices could have a role in making the differential diagnosis of microangiopathy, acute infarction and perfusion-diffusion mismatch lesions.