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Added value in stroke imaging: accuracy and utility of additional coronal diffusion-weighted imaging.

M Baggett1, D Helmy1, J Chang1

  • 1Department of Radiology, University of California, Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.

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Adding coronal diffusion-weighted imaging (DWI) alongside axial views significantly improves small infarct detection in stroke patients. This dual-plane approach enhances diagnostic accuracy, especially for subtle lesions, aiding in better stroke diagnosis.

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Area of Science:

  • Radiology
  • Neuroimaging
  • Medical Imaging

Background:

  • Early detection of small infarcts is crucial for effective stroke management.
  • Standard axial diffusion-weighted imaging (DWI) may miss subtle, small infarcts.
  • Coronal DWI sequences may offer complementary information.

Purpose of the Study:

  • To assess the diagnostic value of adding coronal DWI to standard axial DWI for detecting small infarcts.
  • To evaluate if coronal DWI improves sensitivity and specificity in identifying sub-centimetre infarcts.
  • To determine the utility of multiplanar DWI in stroke imaging protocols.

Main Methods:

  • Retrospective analysis of axial and coronal DWI scans from two data collection rounds.
  • Radiologists identified infarcts using axial-only, coronal-only, and combined axial/coronal images.
  • Quantitative analysis included relative contrast-to-noise ratio (rCNR) and relative mean region of interest (rROI) for lesions.

Main Results:

  • In the second round, combined axial and coronal DWI significantly improved infarct detection sensitivity from 88.9% to 98.1% (p=0.03).
  • Sensitivity for infarct detection was high for both axial (92.7-100%) and coronal (92.7-95.1%) planes individually.
  • Lower rCNR and rROI values were observed in false-negative and false-positive lesions, indicating subtle findings.

Conclusions:

  • Incorporating both axial and coronal DWI with consistent section thickness enhances the detection of small infarcts in stroke protocols.
  • A second imaging plane (coronal) is valuable for identifying subtle infarcts, even without thin-section acquisition.
  • Multiplanar DWI improves diagnostic accuracy, reducing the risk of misdiagnosis on single-plane imaging.