Neuronal damage after ischemic injury in the middle cerebral arterial territory: deep watershed versus territorial infarction at MR perfusion and spectroscopic imaging

Radiology. 2003 Nov;229(2):366-74. doi: 10.1148/radiol.2292020639. Epub 2003 Sep 25.


Purpose: To determine the temporal patterns of neuronal injury between infarction subtypes and their possible association with changes in cerebral blood volume (CBV).

Materials and methods: Twenty-five patients with ischemic injuries of middle cerebral arterial territories and receiving only conservative treatments were classified into territorial infarction (TI) (n = 16) and watershed infarction (WI) (n = 9) groups and were prospectively evaluated with longitudinal magnetic resonance (MR) examinations. Each patient underwent as many as five MR studies at various stroke stages following stroke symptom onset. Dynamic susceptibility-weighted contrast material-enhanced MR imaging was performed to yield the relative CBV (rCBV). Chemical shift imaging was used to measure the relative levels of N-acetylaspartate (NAA) and lactate of the ischemic brain tissue. Repeated-measures analysis of variance was used to examine the statistical significance in evolutional differences between TI and WI.

Results: For patients with TI, rCBV followed a progressively increasing pattern, from initial low values (0.46 +/- 0.28 [SD]) to peak high values (1.23 +/- 0.34) at early chronic stage. Relative NAA level decreased to 0.40 +/- 0.24 during acute stroke and was lost completely 4 days after ictus. Patients with WI showed consistently high rCBV throughout all stages, with residual relative NAA level (0.53 +/- 0.25) even at 1 month after symptom onset. Relative lactate level of patients with TI was significantly higher than that of patients with WI at the acute stage (P <.01). Differences in the temporal changes of both rCBV and brain metabolites between TI and WI were significant (P <.01).

Conclusion: The different temporal patterns for stroke progression in TI and WI are associated with different evolutions of hemodynamics and neuronal injury.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aspartic Acid / analogs & derivatives*
  • Aspartic Acid / analysis
  • Blood Volume
  • Brain / pathology*
  • Brain Chemistry
  • Brain Ischemia / diagnosis*
  • Cerebrovascular Circulation
  • Contrast Media
  • Diagnosis, Differential
  • Disease Progression
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis*
  • Infarction, Middle Cerebral Artery / metabolism
  • Lactic Acid / analysis
  • Magnetic Resonance Imaging*
  • Magnetic Resonance Spectroscopy*
  • Male
  • Middle Aged
  • Neurons / pathology
  • Time Factors


  • Contrast Media
  • Aspartic Acid
  • Lactic Acid
  • N-acetylaspartate