Diffusion-weighted imaging with reverse phase-encoding polarity: the added value to the conventional...

Area of Science:

• Radiology
• Neuroimaging
• Medical Diagnostics

Background:

• Diffusion-weighted imaging (DWI) is crucial for detecting acute ischemic stroke.
• Hyperintense artefacts on DWI can mimic acute brainstem infarctions, posing a diagnostic challenge.

Purpose of the Study:

• To evaluate the diagnostic value of combining reverse phase-encoding polarity DWI (R-DWI) with conventional forward phase-encoding polarity DWI (F-DWI).
• To assess the ability of this combined technique in differentiating acute brainstem infarctions from hyperintense artefacts.

Main Methods:

• Retrospective analysis of 76 patients (38 with acute brainstem infarctions, 38 with artefacts) who underwent both F-DWI and R-DWI.
• Four radiologists independently assessed diagnostic confidence and performance for F-DWI alone versus F-DWI with R-DWI.

Main Results:

• The area under the curve (AUC) for diagnosing infarctions was significantly higher with combined F-DWI and R-DWI compared to F-DWI alone for all readers.
• All readers reported increased confidence in diagnosing infarctions and ruling out artefacts when using the combined R-DWI technique.

Conclusions:

• The addition of R-DWI to F-DWI is a valuable and effective method for distinguishing acute brainstem infarctions from artefacts.
• Combined R-DWI and F-DWI reduces inter-reader variability and improves diagnostic accuracy in brainstem infarction detection.