Related Experiment Video
Updated: Aug 19, 2026
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Identification of embolic stroke patterns by diffusion-weighted MRI in clinically defined lacunar stroke syndromes
Tiemo Wessels1, Carina Röttger, Marek Jauss
1Department of Neurology, Justus-Liebig-University of Giessen, Germany. tiemo.wessels@neuro.med.uni-giessen.de
Background:
A number of clinical syndromes describing the presentation of deep brain infarcts are called lacunar syndromes resulting from small vessel occlusion (SVO). To verify the reliability of the clinical diagnosis "lacunar syndrome," the value was investigated with diffusion-weighted MRI (DWI).
Methods And Results:
A total of 73 patients (mean age 66 years; range 35 to 83 years) with sudden onset of a classical lacunar syndrome were enrolled. On the basis of the DWI findings, patients were divided into 3 groups: group 1, single subcortical lesion (<15-mm lesion; 43 patients; 59%); group 2, large (> or =15 mm) or scattered lesions in 1 vascular territory (16 patients; 22%); and group 3, multiple lesions in multiple vascular territories (14 patients; 19%). A stroke mechanism other than SVO could be identified in 17 (23%) patients. Cardiac work-up revealed a cardiac embolic source in 8 patients (11%). Duplex sonography revealed symptomatic stenosis in 9 patients (12%). Based on the work-up information, 29 patients (40%) were found to have a potential cause of stroke other than SVO. A significant correlation with >1 single lesion on DWI-MRI and a clinical proven embolic source was observed (P=0.002). In 9 patients with MRI suspicious for a pathomechanism other than SVO, no embolic source was found.
Conclusions:
The use of DWI-MRI improves the accuracy of the subtype diagnosis of stroke. Inaccuracy has to be expected in approximately one third if lacunar diagnosis is based on clinical and computed tomography findings. Most of these "false-positive" cases are attributable to large artery or cardiogenic embolic stroke.
Insights
Diffusion-weighted MRI (DWI) improves lacunar stroke diagnosis. Relying solely on clinical or CT findings leads to misdiagnosis in about one-third of cases, often due to large artery or cardiac embolism.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Lacunar syndromes are clinical presentations of deep brain infarcts, often attributed to small vessel occlusion (SVO).
- The diagnostic accuracy of clinical assessment for lacunar syndrome has been questioned.
Purpose of the Study:
- To evaluate the reliability of clinical diagnosis of lacunar syndrome using diffusion-weighted magnetic resonance imaging (DWI).
- To determine the accuracy of DWI in differentiating stroke mechanisms in patients presenting with lacunar syndromes.
Main Methods:
- Seventy-three patients with classical lacunar syndrome were enrolled.
- Diffusion-weighted MRI (DWI) was used to assess infarcts and categorize patients into three groups based on lesion characteristics.
- Further work-up included cardiac evaluation and duplex sonography to identify stroke mechanisms beyond SVO.
Main Results:
- DWI identified stroke mechanisms other than SVO in 40% of patients.
- Cardiac embolism was identified in 11% and symptomatic stenosis in 12% of patients.
- A significant correlation was found between multiple DWI lesions and an embolic source (P=0.002).
Conclusions:
- Diffusion-weighted MRI (DWI) enhances the accuracy of stroke subtype diagnosis.
- Clinical diagnosis alone, or with computed tomography (CT), may lead to misdiagnosis in approximately one-third of lacunar syndrome cases.
- Misdiagnosed cases are frequently due to large artery or cardiogenic embolic strokes.
