Related Experiment Video
Updated: Jan 29, 2026
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Co-analysis of Brain Structure and Function using fMRI and Diffusion-weighted Imaging
Published on: November 8, 2012
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Visual assessment of diffusion weighted imaging infarct volume lacks accuracy and reliability
Naim Khoury1, Cyril Dargazanli2, Adrien Guenego3
1HSHS Neuroscience Center, HSHS Saint John's Hospital, Springfield, Illinois, USA.
Journal of Neurointerventional Surgery
|February 4, 2019
Summary
Visual estimation of diffusion-weighted imaging infarct volume is inaccurate and unreliable for making mechanical thrombectomy decisions in stroke patients using the DAWN criteria, potentially leading to errors.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Mechanical thrombectomy is a key treatment for acute ischemic stroke.
- The DAWN trial established criteria for thrombectomy in late-presenting strokes, utilizing automated infarct volume software (RAPID).
- RAPID software is not universally available, necessitating evaluation of alternative methods.
Purpose of the Study:
- To assess the accuracy and repeatability of visual infarct volume estimation by clinicians.
- To evaluate the impact of visual estimation on thrombectomy decisions based on DAWN criteria.
- To compare visual estimates with automated RAPID measurements.
Main Methods:
- 18 physicians visually estimated diffusion-weighted imaging (DWI) infarct volumes from 32 MRI scans over two sessions.
- Visual estimates were compared to RAPID software measurements for accuracy and repeatability.
- Thrombectomy decisions and inter-rater/intra-rater agreement were analyzed.
Main Results:
- Clinician accuracy in visual infarct volume estimation was below 90% across volume cut-offs.
- Inter-rater agreement was below substantial for all DWI infarct volume cut-offs.
- Using visual estimates instead of RAPID led to 19% erroneous thrombectomy decisions and lacked reproducibility.
Conclusions:
- Visual assessment of DWI infarct volume is inaccurate and lacks repeatability.
- This visual method can lead to significant errors when applying DAWN criteria for thrombectomy decisions.
- Reliance on visual estimation poses a risk to optimal stroke treatment selection.
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