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Early detection of cerebral ischemic lesion using diffusion-weighted MRI
1Department of Neurological Surgery, Ehime University School of Medicine, Japan.
Abstract:
We performed serial diffusion-weighted imaging (DWI) in a patient with right middle cerebral arterial occlusion using 1.0 T MRI. The initial DWI demonstrated suppression of water diffusion in the gray matter in the ischemic lesion as a high signal area 4 h after stroke onset, when T2-weighted imaging failed to detect any parenchymal injury. Repeat DWI 9 h after onset demonstrated the whole infarct, whereas it was not demonstrated by T2-weighted imaging until 48 h. Furthermore, the regional apparent diffusion coefficient (ADC) had already decreased significantly in both the gray and white matters of the ischemic lesion 4 h after onset, even though hyperintensity was not visible in the white matter on the DWI. The features in this case indicate that DWI in conjunction with the assessment of regional ADC can provide important information regarding the evolving infarct at a very early stage even when a relatively low tesla clinically available MRI unit is used.
Insights
Diffusion-weighted imaging (DWI) detects early ischemic stroke changes within 4 hours, outperforming T2-weighted imaging. This technique, using standard MRI, aids in early infarct detection and assessment.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke diagnosis relies on timely and accurate imaging.
- Conventional MRI sequences like T2-weighted imaging have limitations in early infarct detection.
Observation:
- Serial diffusion-weighted imaging (DWI) was performed on a patient with middle cerebral artery occlusion using a 1.0 T MRI.
- Initial DWI at 4 hours post-stroke showed restricted diffusion in the gray matter, while T2-weighted imaging showed no parenchymal injury.
Findings:
- DWI identified the infarct at 4 hours, with significant apparent diffusion coefficient (ADC) reduction in gray and white matter.
- T2-weighted imaging did not visualize the infarct until 48 hours.
- DWI detected evolving infarct changes earlier than T2-weighted imaging.
Implications:
- DWI, combined with ADC assessment, is crucial for early ischemic stroke detection, even with lower-field MRI scanners.
- This imaging approach provides valuable information on infarct evolution in the critical early hours.
- Early DWI findings can guide timely therapeutic interventions in stroke patients.