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Diffusion-weighted MRI in acute subcortical infarction
1Department of Radiology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Background And Purpose:
Conventional imaging lacks sensitivity and specificity for the detection of early subcortical cerebral infarction. The purposes of our study were (1) to determine the accuracy of diffusion-weighted (DW) MRI for early subcortical infarction and (2) to determine the efficacy of DW MRI for differentiating acute from nonacute subcortical infarctions when conventional MR demonstrates multiple infarctions.
Methods:
Thirty-nine patients with clinically diagnosed acute subcortical infarction and 17 control subjects were imaged with both conventional and DW MRI from 7 hours to 4 days (mean, 2.0 days) after onset of symptoms. All images were read blinded to specific clinical findings. In all cases, the precise neuroanatomic locations of lesions were noted. These lesions were subsequently correlated by an experienced stroke neurologist to determine whether their locations correlated to the patients' symptoms.
Results:
The accuracy of DW MRI for acute subcortical infarction was 94.6%. In 4 of 39 cases, the acute infarction was not detected on conventional MRI. In 24 of 39 cases, conventional MRI showed the acute lesion as well as multiple other subcortical lesions. In each of these 24 cases, the DW MRI showed a single lesion to be acute, and in all 24 cases, that lesion corresponded to the patients' acute symptoms.
Conclusions:
DW MRI has very high accuracy for acute subcortical infarction and can differentiate acute from nonacute lesions. These data have significant implications in guiding patient management and patient selection for clinical trials.
Insights
Diffusion-weighted (DW) MRI accurately detects early subcortical infarction. This advanced imaging technique effectively distinguishes acute from nonacute lesions, aiding in patient management.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Conventional imaging methods often fail to detect early subcortical cerebral infarction.
- There is a need for more sensitive and specific diagnostic tools for acute stroke.
Purpose of the Study:
- To assess the accuracy of diffusion-weighted (DW) magnetic resonance imaging (MRI) in identifying early subcortical infarction.
- To evaluate DW MRI's effectiveness in differentiating acute from nonacute subcortical infarctions when conventional MRI shows multiple lesions.
Main Methods:
- Thirty-nine patients with suspected acute subcortical infarction and 17 controls underwent conventional and DW MRI.
- Imaging was performed between 7 hours and 4 days post-symptom onset.
- Experienced neurologists correlated imaging findings with clinical symptoms.
Main Results:
- DW MRI demonstrated 94.6% accuracy for detecting acute subcortical infarction.
- Conventional MRI missed acute infarcts in 4 of 39 cases.
- DW MRI successfully identified the single acute lesion among multiple nonacute lesions in 24 cases, correlating with symptoms.
Conclusions:
- DW MRI offers high accuracy for diagnosing acute subcortical infarction.
- DW MRI is effective in differentiating acute from nonacute subcortical lesions.
- Findings support DW MRI's utility in guiding stroke patient management and clinical trial selection.