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Updated: Nov 7, 2025
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
One-Minute Multi-contrast Echo Planar Brain MRI in Ischemic Stroke: A Retrospective Observational Study of Diagnostic
Annika Kits1,2, Francesca De Luca1,2, Jens Kolloch2
1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Background:
Fast multi-contrast echo planar MRI (EPIMix) has comparable diagnostic performance to standard MRI for detecting brain pathology but its performance in detecting acute cerebral infarctions has not been determined.
Purpose:
To assess the diagnostic performance of EPIMix for the detection of acute cerebral infarctions.
Study Type:
Retrospective observational cohort.
Population:
One hundred and seventy-two consecutive patients with a clinical suspicion of non-hyperacute ischemic stroke (January 2018 to December 2019).
Field Strength And Sequence:
1.5 T or 3 T. EPIMix ((echo-planar based: diffusion weighted (DWI), T2*-weighted, T2-weighted, T2- and T1-fluid attenuated inversion recovery (FLAIR) images) vs. standard MRI: echo-planar DWI, echo-planar T2*-weighted or susceptibility weighted, turbo spin-echo T2-weighted, T2- and T1-FLAIR turbo spin-echo sequences.
Assessment:
Three neuroradiologists rated EPIMix and standard MRI on two separate occasions. Incongruent assessments were resolved in consensus with the fourth reader. The ratings included the diagnostic category (acute infarct, normal, and other pathology). Congruent diagnoses together with consensus diagnoses served as the reference standard.
Statistical Tests:
The diagnostic performance of EPIMix and standard MRI against the reference standard was calculated by the area under the receiver operating characteristic curve (AUC) and compared by DeLong's test. Sensitivity and specificity were determined. Inter-rater agreements were evaluated by Fleiss's kappa.
Results:
Of 172 patients (61 ± 16 years, 103 men), acute infarcts were present in 80/172 (47%), normal findings in 60/172 (35%), and other pathology in 32/172 (19%). Across readers, the AUCs were .94-.95 for EPIMix and .95-.99 for standard MRI, with overlapping 95% CI (P = .02-.18). Inter-rater agreement for EPIMix was 0.90 and for standard MRI was 0.93. The sensitivity for EPIMix and standard MRI was 88-91% and 91-98%, respectively, while the specificity was 98-100% and 98-99%, both with overlapping 95% CI.
Conclusion:
Multi-contrast echo planar MRI showed a high but marginally lower diagnostic performance compared to standard MRI for the detection and characterization of acute brain infarct.
Level Of Evidence:
3 TECHNICAL EFFICACY: Stage 2.
Insights
Fast multi-contrast echo planar MRI (EPIMix) shows high diagnostic performance for detecting acute cerebral infarction, though slightly lower than standard MRI. This study assessed EPIMix
Area of Science:
- Neuroradiology
- Medical Imaging
- Neurology
Background:
- Fast multi-contrast echo planar MRI (EPIMix) demonstrates diagnostic capabilities comparable to standard MRI for general brain pathology.
- The efficacy of EPIMix in detecting acute cerebral infarctions remains undetermined.
Purpose of the Study:
- To evaluate the diagnostic performance of EPIMix for identifying acute cerebral infarctions.
Main Methods:
- A retrospective observational cohort study included 172 patients with suspected non-hyperacute ischemic stroke.
- EPIMix sequences (DWI, T2*-weighted, T2-weighted, T2/T1-FLAIR) were compared against standard MRI protocols.
- Three neuroradiologists assessed image sets, with discrepancies resolved by a fourth reader.
Main Results:
- EPIMix achieved an area under the receiver operating characteristic curve (AUC) of .94-.95, compared to .95-.99 for standard MRI, with overlapping confidence intervals.
- Sensitivity for EPIMix was 88-91% and specificity was 98-100%.
- Inter-rater agreement was high for both methods (EPIMix: 0.90, standard MRI: 0.93).
Conclusions:
- Multi-contrast echo planar MRI offers high diagnostic performance for acute brain infarct detection.
- EPIMix demonstrates marginally lower diagnostic performance compared to standard MRI for acute infarcts.
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