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Use of DWI-only MR protocol for screening stroke mimics
Roni Eichel1, Tamir Ben Hur, John M Gomori
1Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Purpose:
Patients presenting with focal neurological symptoms may suffer from stroke or stroke mimics. Diffusion weighted MRI (DWI) is highly sensitive for identifying acute ischemia. Therefore, we aimed to explore whether a DWI-only protocol would help differentiate stroke from stroke mimics.
Methods:
We identified all patients with possible but not definite stroke that underwent DWI-only MRI between 6/2010 and 8/2011. Patients with a positive DWI lesion were compared to those with negative DWI findings on demographics, risk factor profile, final discharge diagnoses, and outcome.
Results:
A total of 124 patients were included with a median age of 63.5 (53% male). DWI MRI was positive for acute ischemia in 46 patients (37%). The most frequent stroke mimics were peripheral vertigo (n=19), acute confusion (n=10), seizures (n=9) and migraine with aura (n=8). Most ischemic lesions were small on DWI (<2 cm) and patients had minor disability (mean NIHSS 4.9±3.9) with 81% of patients having good outcomes (modified Rankin Score≤2) at 3 months. On univariate analysis patients with positive DWI studies had higher frequencies of having more than one clinical symptom (56% vs. 13% respectively; P<0.001) and this variable remained a significant predictor for stroke on multivariate analysis (OR 9.4 95% CI 3.8-23.5).
Conclusions:
A short DWI-only MRI protocol can effectively differentiate stroke from stroke mimics and could be used in settings of the emergency department as well as later on for diagnostic purposes. The chances for finding positive DWI lesions are increased in patients with multiple symptoms and signs.
Insights
A diffusion-weighted imaging (DWI)-only MRI protocol effectively distinguishes stroke from stroke mimics. Multiple neurological symptoms significantly increase the likelihood of detecting acute ischemic lesions on DWI scans.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Focal neurological symptoms can indicate stroke or stroke mimics.
- Diffusion-weighted MRI (DWI) is a sensitive tool for detecting acute ischemia.
- Differentiating stroke from mimics is crucial for timely and appropriate patient management.
Purpose of the Study:
- To evaluate the efficacy of a DWI-only MRI protocol in differentiating acute stroke from stroke mimics.
- To assess the diagnostic value of DWI in emergency settings for neurological symptoms.
Main Methods:
- Retrospective analysis of 124 patients with suspected stroke undergoing DWI-only MRI.
- Comparison of patients with positive DWI lesions versus negative DWI findings.
- Analysis of demographic data, risk factors, diagnoses, and patient outcomes.
Main Results:
- DWI MRI identified acute ischemia in 37% of patients.
- Common stroke mimics included peripheral vertigo, confusion, seizures, and migraine with aura.
- Multiple clinical symptoms were a significant predictor of stroke (OR 9.4).
Conclusions:
- A concise DWI-only MRI protocol is effective for differentiating stroke from stroke mimics.
- This protocol can be utilized in emergency departments and for diagnostic purposes.
- The presence of multiple neurological symptoms increases the probability of positive DWI findings for stroke.
