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Is Diffusion-Weighted-Image (DWI) Sequence Reliable in Acute Large Vessel Hemispheric Ischemic Infarction?
Sang Bin Hong1, Young-Seok Lee2
1Department of Neurology, Seoul National University Hospital; Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea.
Neurology India
|December 20, 2022
Summary
Diffusion-weighted imaging (DWI) may not show changes in large hemispheric strokes, even with prolonged symptoms. Early recognition of these diffusion-negative cases is crucial for timely stroke treatment.
Area of Science:
- Neuroradiology
- Neurology
- Stroke Imaging
Background:
- Diffusion-weighted imaging (DWI) is a key tool for diagnosing acute ischemic stroke.
- Restricted diffusion on DWI typically indicates early ischemic changes.
Observation:
- Three cases of large hemispheric stroke with prolonged symptoms (hours) showed no or subtle DWI changes.
- This challenges the universal reliability of DWI in all acute stroke presentations.
Findings:
- Large hemispheric ischemic strokes may not present with definitive DWI signal abnormalities.
- The absence of clear DWI changes can occur despite significant clinical symptoms.
Implications:
- Accurate identification of diffusion-negative large hemispheric strokes is critical.
- This diagnostic window is vital for initiating acute medical treatments and neuro-interventions.
- Further research into advanced imaging or alternative markers may be needed.
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