Apparent diffusion coefficient (ADC) is a measure of the magnitude of diffusion (of
water molecules) within tissue, and is commonly clinically calculated using MRI
with diffusion weighted imaging (DWI) 1.
Basics
Diffusion-weighted imaging (DWI) is widely appreciated as an indispensable tool in
the examination of the CNS. It is considered useful not only for the detection of
acute ischaemic stroke but also for the characterization and differentiation of
brain tumors and intracranial infections.
DWI exploits the random motion of water molecules. The extent of tissue cellularity
and the presence of intact cell membrane help determine the impedance of water
molecule diffusion. This impedance of water molecules diffusion can be
quantitatively assessed using the apparent diffusion coefficient (ADC) value. This
assessment can be done using different b values via changing gradient amplitude
2,3,6.
Measurement
ADC values are calculated automatically by the software and then displayed as a
parametric map that reflects the degree of diffusion of water molecules through
different tissues. Then, by use of a dedicated workstation, ADC measurements are
recorded for a given region by drawing regions of interest (ROIs) on the ADC map 6.
An ADC of a tissue is expressed in units of mm2/s. There is no unanimity regarding
the boundaries of the range of normal diffusion, but ADC values less than 1.0 to
1.1 x 10-3 mm2/s (or 1000-1100 x 10-6 mm2/s) are generally acknowledged in adults
as indicating restriction. However, this is entirely dependent on the organ being
imaged and the pathology 7.
Some rough useful values (10-6 mm2/s) 8-10:
white matter: 670-800
cortical grey matter: 800-1000
deep grey matter: 700-850
CSF: 3000-3400
astrocytoma
Gd II: 1273 � 293
Gd III: 1067 � 276
Gd IV: 745 � 135
Diffusion changes are correlated to the clinical deficit and are potentially useful
for early diagnosis and longitudinal evaluation, especially in the context of
pharmacological trials.
On the trace DW image (left) the stroke appears white, while on the ADC map (right)
it appears dark
T2 DWI ADC
� hyperacute (< 6hrs) iso high low
� acute (6hrs to 4 d) high high low
� subacute (4 to 10 d) high iso/h iso
� chronic (>10 d) high iso/l high
What is PWI?
Collect serial EPI images
Inject contrast agent:Perfused brain - dark; Ischemic brain - bright
Perfusion deficit present: low rCBF, long rMTT
Reduced ADC �cytoxic� vs. reduced mobility.
Screen for �non-stroke� events (headaches, TIA).
Secondary ischemia (acute trauma, venous occlusion)
ADC reduced in �cytotoxic� edema: CJD, pediatric diseases.
ADC reduced in abscess ** vs. highly cellular tumor cores.
ADC increased in vasogenic edema
