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Updated: Nov 10, 2025
09:59
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
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Improved Detectability of Brain Stem Ischemia by Combining Axial and Coronal Diffusion-Weighted Imaging
Paul Steffen1,2, Lara-Sophie Beyer1, Rosalie McDonough2
1Department of Diagnostic and Interventional Radiology (P.S., L.-S.B., C.T., T.F., C.R.H.), Marienkrankenhaus Hamburg, Germany.
Stroke
|April 5, 2021
Summary
Adding coronal diffusion-weighted imaging (DWI) to standard axial DWI significantly improves brain stem infarction detection. Combined DWI sequences offer the best diagnostic performance for these critical neurological events.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Brain stem infarctions present diagnostic challenges.
- Standard axial diffusion-weighted imaging (DWI) may have limitations in detecting these lesions.
Purpose of the Study:
- To evaluate the added benefit of coronal DWI sequences in detecting brain stem infarctions.
- To compare the diagnostic performance of axial DWI, coronal DWI, and combined DWI.
Main Methods:
- Retrospective analysis of 239 patients with suspected brain stem infarction.
- Inclusion of axial and coronal DWI sequences in magnetic resonance imaging.
- Independent blinded review of DWI sequences in three steps: axial, coronal, and combined.
Main Results:
- Combined axial and coronal DWI demonstrated superior sensitivity (90.3%) and specificity (99.1%) compared to axial (85.5%, 94.9%) or coronal (87.9%, 96.5%) alone.
- Interobserver agreement was highest with the combined DWI assessment (Cohen κ=0.94).
- Combined DWI identified 112/124 infarctions versus 106/124 on axial and 109/124 on coronal.
Conclusions:
- Coronal DWI sequences enhance the detection of brain stem infarctions.
- The combination of axial and coronal DWI provides optimal diagnostic yield with minimal increase in scan time.
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