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Diffusion-weighted imaging in acute stroke--a tool of uncertain value?
Jens Fiehler1, Jochen B Fiebach, Achim Gass
1Department of Neuroradiology, University Hospitals of Hamburg-Eppendorf, Hamburg, Germany. fiehler@uke.uni-hamburg.de
Abstract:
The concept of a mismatch between the lesion volume in diffusion- and perfusion-weighted magnetic resonance imaging (MRI) indicating 'tissue at risk of infarction' is based on the assumption that tissue with diffusion slowing in diffusion-weighted MRI (DWI) or decreased values of the apparent diffusion coefficient represents irreversibly damaged tissue. Recent experimental as well as clinical studies, however, have shown that tissue with diffusion slowing may well normalize if the hypoperfusion is moderate or transient. We will interpret these findings in the light of experimental data and suggest a way for the interpretation of different time courses of lesion development in DWI within a clinical MRI protocol. MR stroke imaging delivers important information in acute stroke, particularly in defining the 'tissue at risk of infarction'.
Insights
Diffusion-weighted MRI (DWI) may overestimate infarct core in acute stroke. Mild or temporary hypoperfusion can allow diffusion slowing to normalize, impacting
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- The established concept of 'tissue at risk of infarction' in acute stroke relies on diffusion-weighted MRI (DWI) lesion volume.
- This concept assumes that diffusion slowing on DWI indicates irreversible tissue damage.
Purpose of the Study:
- To re-evaluate the interpretation of DWI findings in acute stroke.
- To propose a revised approach for interpreting lesion development in DWI within clinical MRI protocols, considering experimental and clinical data.
Main Methods:
- Interpretation of experimental and clinical data on diffusion slowing and hypoperfusion.
- Analysis of time-course lesion development in DWI.
Main Results:
- Recent studies indicate that diffusion slowing in DWI may not always represent irreversible damage.
- Moderate or transient hypoperfusion can lead to normalization of diffusion-slowing tissue.
Conclusions:
- The assumption that diffusion slowing equals irreversible damage needs reconsideration.
- A nuanced interpretation of DWI lesion evolution is crucial for accurately defining infarct core and penumbra in acute stroke imaging.
