Is Diffusion-Weighted-Image (DWI) Sequence Reliable in Acute Large Vessel Hemispheric Ischemic Infarction?
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Updated: Aug 16, 2025

Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Sang Bin Hong1, Young-Seok Lee2
1Department of Neurology, Seoul National University Hospital; Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea.
Abstract:
The appearance of restricted-diffusion on the diffusion-weighted image (DWI) sequence is a reliable radiologic marker in acute ischemic stroke. Exceptions may occur in small brainstem strokes shortly after symptom onset. Three large hemispheric stroke cases with clinical symptoms lasting hours without any or only subtle DWI changes are identified over six years by the senior author. Even large hemispheric ischemic strokes with symptoms lasting hours may not reveal definitive DWI signal changes. Recognition and characterization of diffusion-negative large hemispheric stroke cases are important since this period represents a window of opportunity for acute medical treatment and/or neuro-intervention.
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