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Iatrogenic Diffusion-Weighted Imaging Lesions: What Is Their Impact and How Can It Be Measured?
Mayank Goyal1,2, Aravind Ganesh1, Michael Tymianski3
1Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.
Abstract:
Infarct volume in acute ischemic stroke is closely linked with clinical outcome, with larger infarct volumes being associated with a worse prognosis. Small iatrogenic infarcts, which can occur as a result of surgical or endovascular procedures, are often only seen on diffusion-weighted MR imaging. They often do not lead to any overtly appreciable clinical deficits, hence the term covert or silent infarcts. There is relative paucity of data on the clinical impact of periprocedural hyperintense diffusion-weighted MR imaging lesions, partly because they commonly remain undiagnosed. Clearly, a better understanding of iatrogenic periprocedural diffusion-weighted MR imaging lesions and their clinical significance is needed. In this article, we describe the current limitations of our understanding of the significance of iatrogenic diffusion-weighted MR imaging lesions using exemplary data from the ENACT trial (Safety and Efficacy of NA-1 in Patients With Iatrogenic Stroke After Endovascular Aneurysm Repair) and outline a framework for how to investigate their clinical impact.
Insights
Small, often undetected, iatrogenic infarcts from procedures can impact acute ischemic stroke outcomes. Further research is needed to understand the clinical significance of these silent diffusion-weighted MR imaging lesions.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Interventions
Background:
- Infarct volume in acute ischemic stroke correlates with clinical outcomes.
- Iatrogenic infarcts from procedures are often small and detected only on diffusion-weighted MR imaging (DW-MRI).
- These "silent" infarcts frequently lack overt clinical deficits, complicating impact assessment.
Purpose of the Study:
- To address the paucity of data on the clinical impact of periprocedural DW-MRI lesions.
- To describe current understanding limitations of iatrogenic DW-MRI lesions.
- To propose a framework for investigating the clinical significance of these lesions.
Main Methods:
- Utilized exemplary data from the ENACT trial (Safety and Efficacy of NA-1 in Patients With Iatrogenic Stroke After Endovascular Aneurysm Repair).
- Focused on diffusion-weighted MR imaging findings.
- Described limitations in current understanding and proposed an investigative framework.
Main Results:
- Iatrogenic periprocedural hyperintense DW-MRI lesions are often undiagnosed.
- Existing data on their clinical impact is limited.
- Exemplary data highlights the need for better understanding.
Conclusions:
- A better understanding of iatrogenic DW-MRI lesions is crucial.
- Investigating the clinical significance of these lesions requires a structured approach.
- The ENACT trial provides a basis for future research into silent periprocedural infarcts.
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