Added Value of Thin-Section Coronal DWI for Lesion Visualization in Acute Brainstem Infarction: A Retrospective...

Area of Science:

• Neuroradiology
• Neuroimaging
• Stroke Imaging

Background:

• Brainstem infarctions are difficult to detect using conventional axial diffusion-weighted imaging (DWI) due to anatomical complexity and limitations.
• Thin-section coronal DWI offers higher spatial resolution and an orthogonal view, potentially improving lesion conspicuity.

Purpose of the Study:

• To evaluate if 3 mm thin-section coronal DWI improves visualization and delineation of acute brainstem infarctions compared to standard 4 mm axial DWI.

Main Methods:

• Retrospective analysis of 125 patients with MRI-confirmed acute brainstem infarction.
• Comparison of lesion visualization between axial and coronal DWI acquisitions.
• Manual lesion volume calculation and independent neuroradiologist interpretation.
• Assessment of interobserver agreement using Cohen's kappa and ICC.

Main Results:

• Coronal DWI demonstrated improved or equivalent visualization in all cases.
• Improved visualization was most notable in midbrain (100%) and some medullary lesions (26.7%).
• Lesions better visualized on coronal DWI were significantly smaller (mean ~0.23 mL vs. ~0.55 mL).
• Twelve midbrain and eight medullary lesions were identified exclusively on coronal DWI.

Conclusions:

• Thin-section coronal DWI enhances the visualization and delineation of small brainstem infarctions.
• This technique is particularly beneficial for lesions in compact anatomical regions like the midbrain.
• Coronal DWI serves as a valuable complementary sequence to standard axial imaging for brainstem infarction diagnosis.