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Ultra-high b value DWI in distinguishing fresh gray matter ischemic lesions from white matter ones: a comparative
Xinming Huang1, Xue Xu1, Yifan Sun1
1Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
Background:
Fresh ischemic lesions (FILs) can occur in both the brain's gray matter (GM) and white matter (WM), with each location signifying a different prognosis for patients. This study aims to investigate the application of ultra-high b value diffusion-weighted imaging (DWI) in distinguishing FILs in these two areas via a comparative study with routine and high b value DWI.
Methods:
Multiple b value DWI (b=0, 500, 1,000, 2,000, 4,000, 6,000, 8,000, 10,000 s/mm2) was performed on 47 patients with suspected acute ischemic stroke (AIS). Apparent diffusion coefficient (ADC) maps, including ADC500, ADC1,000, ADC2,000, ADC4,000, ADC6,000, ADC8,000, and ADC10,000, were calculated, and the mean ADC value of the FILs in the GM and WM on each map was obtained by referring to the structural magnetic resonance imaging (MRI). ADC value differences of the FILs in the GM and WM were compared using Mann-Whitney U tests, and receiver operating characteristic (ROC) curves evaluated the diagnostic efficiency of each ADC value in distinguishing FILs in the two areas.
Results:
In the enrolled 34 patients, 145 FILs were identified, of which 42 involved the GM, 87 the WM, and 16 both the GM and WM. A total of 161 regions were delineated, 58 in the GM and 103 in the WM. The values of FILs in the WM on ADC2,000, ADC4,000, ADC6,000, ADC8,000, and ADC10,000 maps were significantly lower than those in the GM (P=0.007, P<0.001, P<0.001, P<0.001 and P<0.001, respectively), while no significant differences were found on ADC500 and ADC1,000 maps (P=0.427 and P=0.225, respectively). ROC curves demonstrated that the area under the curve (AUC) paralleled the increasing b value, ascending from ADC500 to ADC10,000 (0.538, 0.558, 0.629, 0.766, 0.827, 0.859, 0.872, in that order).
Conclusions:
Ultra-high b value DWI is extremely sensitive to the slight diffusion difference between FILs in the GM and the WM. Its sensitivity parallels the increasing b value, indicating its clinical advantage in identifying the microstructure of FILs.
Insights
Ultra-high b value diffusion-weighted imaging (DWI) effectively distinguishes fresh ischemic lesions (FILs) in gray matter (GM) and white matter (WM). Higher b values show increased sensitivity in differentiating these lesion types.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Fresh ischemic lesions (FILs) in gray matter (GM) and white matter (WM) have different prognoses.
- Distinguishing FILs in GM vs. WM is crucial for patient outcomes.
Purpose of the Study:
- To evaluate ultra-high b value diffusion-weighted imaging (DWI) for differentiating FILs in GM and WM.
- To compare its efficacy against routine and high b value DWI.
Main Methods:
- Performed multi-b value DWI (up to 10,000 s/mm²) on 47 patients with suspected acute ischemic stroke (AIS).
- Calculated apparent diffusion coefficient (ADC) maps and compared mean ADC values between GM and WM FILs.
- Utilized Mann-Whitney U tests and receiver operating characteristic (ROC) curves for analysis.
Main Results:
- Significantly lower ADC values were observed in WM FILs compared to GM FILs at b values of 2,000 s/mm² and higher (P<0.001).
- No significant differences were found at b values of 500 and 1,000 s/mm².
- Area under the curve (AUC) in ROC analysis increased with b value, reaching 0.872 at 10,000 s/mm².
Conclusions:
- Ultra-high b value DWI demonstrates high sensitivity in detecting diffusion differences between GM and WM FILs.
- Increasing b values enhance the ability to differentiate lesion microenvironments.
- This technique offers clinical advantages for identifying FIL microstructure.
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