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Are you right when it’s bright?
Bright cortical signal on diffusion images is classically associated w/hypoxic-ischemic injury.
But there are many mimics!
Do you know how to recognize the different patterns of cortical restricted diffusion? Here’s a figure & some pearls to help!
Cortical restricted diffusion many seen in a variety of conditions—many with VERY different pathophysiology & prognosis.
There are 6 main patterns:
(1) Cortex & deep gray
(2) Diffuse Cortex
(3) Focal Cortex
(4) Limbic
(5) Deep gray
(6) White matter
Here are some steps to help differentiate:
(1) Is the presentation acute or chronic?
(2) If it’s acute, toxic-metabolic & hypoxic-ischemic events account for the majority of cases. Seizure & encephalitis are less frequent and typically more focal
(3) In the chronic setting, isolated cortical involvement is almost diagnostic of CJD
Hopefully, this will clear up any confusion about the diffusion!
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