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Diffusion MRI in ischemic stroke compared to pathologically verified infarction
P J Kelly1, E T Hedley-Whyte, J Primavera
1Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA. pjkelly@partners.org
Background:
Diffusion MRI abnormality correlates with pathology in animal ischemic stroke models. A combined retrospective and prospective analysis of consecutive patients over a 3-year period who had a clinical diagnosis of probable new ischemic stroke, underwent diffusion MRI, and were later studied at autopsy was performed.
Methods:
Inclusion criteria for the retrospective analysis were 1) symptom onset within 14 days of presentation, 2) diffusion MRI within 28 days of symptom onset, and 3) autopsy within 16 weeks of symptom onset. Patients with suspected further infarcts between MRI and autopsy were excluded. The locations of all areas of MRI abnormality were identified by a blinded neuroradiologist, and recent infarcts were identified by review of pathologic records and microscopic slides.
Results:
Eleven patients were identified who fulfilled inclusion criteria, with 25 discrete pathologic infarcts. Diffusion MRI abnormality corresponded to pathologically verified infarction in 23 cases, was present in two locations where no pathologic infarct was identified, and was absent in two locations where an infarct was present at autopsy. In two cases, despite clinical suspicion of acute ischemic stroke, no MRI abnormality or pathologic infarct was found. The sensitivity and specificity of diffusion MRI were 88.5% (95% CI, 69.9% to 97.6%) and 96.6% (95% CI, 91.5% to 99.1%). Accuracy was 95.1% (95% CI, 90.2% to 98%). Three further patients who died during the course of the retrospective analysis were studied prospectively, and are described separately.
Conclusions:
These findings suggest high accuracy of diffusion MRI for detection of ischemic infarction compared with pathologic examination.
Insights
Diffusion MRI accurately detects ischemic stroke, correlating well with autopsy findings. This imaging technique shows high sensitivity and specificity for identifying infarction, aiding clinical diagnosis.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Diffusion MRI is a key neuroimaging technique for detecting acute ischemic stroke.
- Previous studies in animal models show diffusion MRI abnormalities correlate with ischemic stroke pathology.
- This study investigates the diagnostic accuracy of diffusion MRI in human patients against autopsy confirmation.
Observation:
- A combined retrospective and prospective analysis included 11 patients with probable ischemic stroke confirmed by autopsy.
- Diffusion MRI was performed within 28 days of symptom onset and autopsy within 16 weeks.
- A blinded neuroradiologist identified MRI abnormalities, compared with pathologic records.
Findings:
- Diffusion MRI correctly identified infarction in 23 out of 25 cases (88.5% sensitivity).
- The technique showed high specificity (96.6%) and accuracy (95.1%) in detecting ischemic infarction.
- Two cases showed MRI abnormalities without infarcts, and two infarcts were missed by MRI.
Implications:
- Diffusion MRI demonstrates high accuracy for detecting ischemic infarction, supporting its clinical utility.
- These findings validate diffusion MRI as a reliable tool for diagnosing ischemic stroke.
- The study provides strong evidence for using diffusion MRI in clinical practice for stroke evaluation.