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

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.