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Published on: September 19, 2019
Patient characteristics with negative diffusion-weighted imaging findings in acute lateral medullary infarction
Junichiro Ohira1, Nobuyuki Ohara2, Takuya Hinoda3
1Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan. j.ohira0614@gmail.com.
Background:
Diffusion-weighted imaging (DWI) on magnetic resonance imaging (MRI) shows limited sensitivity in the acute-phase brainstem infarctions, including lateral medullary infarction (LMI), and the detailed characteristics of acute LMI patients with initially negative DWI-MRI findings have not been reported previously. Therefore, we aimed to investigate the differences in the backgrounds or symptoms of acute LMI patients with initially negative findings in standard axial DWI-MRI and those with positive findings.
Methods:
In this retrospective cohort study, we collected the data for 35 consecutive acute LMI patients who were hospitalized in our hospital from January 2011 to December 2018. Initial standard axial DWI-MRI was assessed, and the patients were divided into positive and negative groups. The characteristics of the two groups were compared, and the usefulness of additional thin-slice coronal DWI-MRI was also investigated.
Results:
Nine (26%) acute LMI patients were initially negative on standard axial DWI-MRI. The patients were independently associated with smoking history (78% vs. 23%, p = 0.021) and headache (78% vs. 31%, p = 0.046). Thin-slice coronal DWI-MRI showed positive findings in 50% of the patients with negative findings in standard axial DWI-MRI. All four patients with negative findings in both standard axial and thin-slice coronal DWI-MRI had smoking history and headache.
Conclusion:
Smoking history and headache were associated with initial negative results in standard axial DWI-MRI in acute LMI. Additional thin-slice coronal DWI-MRI was sometimes useful in detecting acute LMI. Follow-up MRI is important for patients showing negative findings in initial DWI-MRI.
Insights
Acute lateral medullary infarction (LMI) can be missed by initial diffusion-weighted imaging (DWI) MRI. Smoking history and headache were linked to negative DWI findings, suggesting follow-up MRI is crucial.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Diffusion-weighted imaging (DWI) on magnetic resonance imaging (MRI) has limited sensitivity for acute brainstem infarctions like lateral medullary infarction (LMI).
- Detailed characteristics of acute LMI patients with initially negative DWI-MRI findings remain underreported.
Purpose of the Study:
- To investigate differences in backgrounds and symptoms between acute LMI patients with initially negative standard axial DWI-MRI findings and those with positive findings.
- To assess the utility of additional thin-slice coronal DWI-MRI in detecting acute LMI.
Main Methods:
- Retrospective cohort study of 35 consecutive acute LMI patients hospitalized between January 2011 and December 2018.
- Patients were divided into positive and negative groups based on initial standard axial DWI-MRI findings.
- Comparison of patient characteristics and evaluation of thin-slice coronal DWI-MRI usefulness.
Main Results:
- 26% (9/35) of acute LMI patients had initially negative standard axial DWI-MRI.
- Negative DWI findings were independently associated with smoking history (78% vs. 23%) and headache (78% vs. 31%).
- Thin-slice coronal DWI-MRI detected LMI in 50% of patients with initially negative standard axial DWI-MRI; all patients with negative findings on both sequences had smoking history and headache.
Conclusions:
- Smoking history and headache are associated with initial negative standard axial DWI-MRI results in acute LMI.
- Additional thin-slice coronal DWI-MRI can be beneficial for detecting acute LMI.
- Follow-up MRI is essential for patients with initially negative DWI-MRI findings in suspected acute LMI.
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