Patterns of accentuated grey-white differentiation
on diffusion-weighted imaging or the apparent
diffusion coefficient maps in comatose survivors
after global brain injury
- Affiliated Author(s)
- Alternative Author(s)
- Chang, Hyuk Won
- Journal Title
- Clinical Radiology
- Issued Date
- AIM: To determine what disease entities show accentuated greyewhite differentiation of the
cerebral hemisphere on diffusion-weighted images (DWI) or apparent diffusion coefficient
(ADC) maps, and whether there is a correlation between the different patterns and the cause of
the brain injury.
METHODS AND MATERIALS: The DWI and ADC maps of 19 patients with global brain injury
were reviewed and evaluated to investigate whether there was a correlation between the
different patterns seen on the DWI and ADC maps and the cause of global brain injury. The ADC
values were measured for quantitative analysis.
RESULTS: There were three different patterns of ADC decrease: a predominant ADC decrease
in only the cerebral cortex (n¼ 8; pattern I); an ADC decrease in both the cerebral cortex and
white matter (WM) and a predominant decrease in the WM (n ¼ 9; pattern II); and
a predominant ADC decrease in only the WM (n ¼3; pattern III).
CONCLUSION: Pattern I is cerebral cortical injury, suggesting cortical laminar necrosis in
hypoxic brain injury. Pattern II is cerebral cortical and WM injury, frequently seen in brain
death, while pattern 3 is mainly WM injury, especially found in hypoglycaemic brain injury. It
is likely that pattern I is decorticate injury and pattern II is decerebrate injury in hypoxic
ischaemic encephalopathy.Patterns I and II are found in severe hypoxic brain injury, and
pattern II is frequently shown in brain death, whereas pattern III was found in severe hypoglycaemic
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