Diffusion-weighted imaging in hyperacute haemorrhagic stroke patients presenting within thrombolysis window

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Diffusion-weighted imaging (DWI) is a proposed first-line neuroimaging for acute ischemic stroke.
• Its reliability in detecting intracranial hemorrhage (ICH) is less established compared to SWI and CT.
• This study evaluates DWI's role in identifying ICH in patients within the thrombolysis window.

Purpose of the Study:

• To establish the reliability of DWI as a first-line neuroimaging modality for detecting intracranial hemorrhage in acute stroke patients.
• To compare DWI findings with established gold standards (SWI and CT) for ICH detection.
• To assess DWI's accuracy in identifying ICH in patients presenting within the thrombolysis window.

Main Methods:

• Retrospective cross-sectional analysis of 31 acute stroke patients who underwent MRI brain as first-line neuroimaging.
• Radiologists assessed DWI signal patterns for ICH.
• DWI findings were compared with susceptibility-weighted imaging (SWI) and CT Brain (when available) as gold standards.

Main Results:

• The majority of hyperacute bleeds detected by SWI/CT showed characteristic DWI findings (central hyperintensity, peripheral hypointense rim).
• DWI demonstrated exceptionally high sensitivity, specificity, positive predictive value, and negative predictive value for intra-axial hemorrhages.
• Strong interobserver agreement (kappa = 0.94) was observed in identifying central hemorrhagic signal intensity.

Conclusions:

• DWI is a reliable MRI sequence for detecting intracranial hemorrhage in hyperacute stroke.
• The findings support the use of DWI as a dependable first-line imaging modality for ICH in acute stroke.
• DWI's high accuracy and reliability enhance its utility in time-sensitive stroke diagnosis and management.