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Dr. James Abrahams
responds:
Edema from a met or tumor is usually in the white matter and does not involve
the cortex radiographically. The gray-white (cortical-medullary) junction
is therefore more easily seen on CT because the white matter becomes darker.
An infarct, on the other hand, involves the cortex and causes edema of the
cortex. This edema causes the cortex to become slightly darker to the point
where it takes on the same color as the white matter. Thus, the gray and
white matter have the same color and there is loss of the gray-white junction
with an infarct. If one is dealing with a lacuna, or white matter infarct,
then all bets are off. One can not differentiate this edema from a tumor
and contrast should be given if there is any question of a tumor.
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