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Experience with diffusion-weighted imaging in an acute stroke unit
S J Read1, G D Jackson, D F Abbott
1Department of Medicine (Neurology), Centre for Brain Imaging Research, University of Melbourne and Austin and Repatriation Medical Centre, Australia.
Abstract:
We performed diffusion-weighted MRI (DWI) on a standard 1.5-tesla MRI scanner using a high-speed stimulated echo pulse sequence (turboSTEAM) in 9 stroke patients and 9 control subjects to investigate whether this technique can be used clinically to assist in ischaemic stroke diagnosis within the time frame for potential therapy. Stroke patients underwent DWI between 3.75 h and 3 days after stroke onset. Three patients were studied on more than one occasion. DWI was normal in the 9 controls. Seven of 9 stroke patients showed areas of increased signal on DWI. DWI detected cerebral ischaemia 3.75 h after stroke onset when both CT and T2-weighted MRI were normal. In 6 DWI-positive patients studied at later times, increased signal on T2-weighted images was present at the same time. Two patients had normal CT, T2-weighted and DWI images; both made good neurological recoveries. For the routine assessment of stroke patients, DWI implemented on a standard MRI system can provide additional information of clinical value to that obtained with conventional pulse sequences. In particular it facilitates early detection of cerebral ischaemia during the first few hours after stroke.
Insights
Diffusion-weighted MRI (DWI) aids in early ischemic stroke diagnosis. This technique detects cerebral ischemia within hours of stroke onset, even when CT and T2-weighted MRI are normal.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Ischemic stroke diagnosis requires timely detection for effective therapy.
- Conventional MRI sequences (CT, T2-weighted) may not detect early ischemic changes.
- Diffusion-weighted MRI (DWI) offers potential for earlier detection.
Purpose of the Study:
- To evaluate the clinical utility of DWI for early ischemic stroke diagnosis.
- To assess if DWI can identify cerebral ischemia within the therapeutic time window.
- To compare DWI findings with conventional MRI and CT in stroke patients.
Main Methods:
- Diffusion-weighted MRI (DWI) using a turboSTEAM sequence on a 1.5-tesla scanner.
- Study included 9 acute ischemic stroke patients and 9 healthy controls.
- DWI scans were performed between 3.75 hours and 3 days post-stroke onset.
Main Results:
- DWI scans were normal in all 9 control subjects.
- Seven out of 9 stroke patients showed increased signal intensity on DWI, indicating ischemia.
- DWI detected cerebral ischemia as early as 3.75 hours post-stroke, when CT and T2-weighted MRI were normal.
Conclusions:
- DWI on standard MRI systems provides valuable information for stroke assessment.
- DWI facilitates the early detection of cerebral ischemia, crucial for timely therapeutic intervention.
- DWI enhances diagnostic capabilities beyond conventional MRI sequences in acute stroke cases.