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Related Experiment Videos

Diffusion-weighted imaging in hyperacute stroke--gold standard?

Y-Y Wong1, W W-M Lam

  • 1Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong. wynnie@cuhk.edu.hk

Acta Radiologica (Stockholm, Sweden : 1987)
|September 27, 2003
PubMed
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Diffusion-weighted imaging (DWI) detects early cerebral ischemia better than CT. However, this case shows DWI may initially miss acute stroke progression in some patients.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Diffusion-weighted imaging (DWI) is a key MRI technique for detecting acute ischemic stroke.
  • Early cerebral ischemia and infarction are typically well-visualized by DWI.
  • Conventional T2-weighted MRI and CT scans have limitations in early stroke detection compared to DWI.

Observation:

  • A 79-year-old woman presented with acute stroke symptoms.
  • Clinical and radiological progression to a complete stroke was documented.
  • Initial diffusion-weighted imaging (DWI) scan results were negative for ischemia.

Findings:

  • Despite the known high sensitivity of DWI for early cerebral ischemia, the initial scan failed to detect the stroke.
  • The case highlights a potential diagnostic challenge where DWI may not immediately reveal evolving ischemic changes.

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  • Subsequent clinical and radiological evidence confirmed a completed stroke.

    • Implications:

    • This case underscores the importance of considering clinical presentation alongside imaging findings in acute stroke diagnosis.
    • It suggests that in rare instances, a negative initial DWI may not entirely exclude acute cerebral ischemia, especially with progressing symptoms.
    • Further investigation or follow-up imaging might be warranted in equivocal cases presenting with stroke symptoms and a negative initial DWI.