Diffusion-weighted MR of acute cerebral infarction: comparison of data processing methods

Area of Science:

• Neuroradiology
• Medical Imaging

Background:

• Accurate interpretation of diffusion-weighted imaging (DWI) in acute stroke is crucial.
• Potential pitfalls include diffusion anisotropy, magnetic susceptibility artifacts, and T2 effects.
• Quantitative diffusion maps (e.g., apparent diffusion coefficient [ADC] maps) are proposed to mitigate these issues.

Purpose of the Study:

• To compare the diagnostic performance of simple, orthogonal-axis DWI with processed images.
• To evaluate sensitivity, specificity, and accuracy for early cerebral infarction detection.
• To determine if complex post-acquisition processing is essential for clinical stroke imaging.

Main Methods:

• Twenty-six patients with suspected early cerebral infarction and 17 controls underwent 1.5 T MRI.
• Multisection, single-shot, spin-echo echo-planar DWI was used to acquire orthogonal-axis images.
• Isotropic DWI, diffusion trace-weighted, and diffusion trace (mean ADC) images were generated offline.

Main Results:

• Orthogonal-axis DWI achieved 98.1% sensitivity, 97.1% specificity, and 97.7% accuracy.
• Isotropic DWI showed 88.5% sensitivity, 100% specificity, and 93% accuracy.
• Diffusion trace-weighted and diffusion trace images demonstrated significantly lower diagnostic performance.

Conclusions:

• Orthogonal-axis DWI provides the highest sensitivity and accuracy for diagnosing early cerebral infarction.
• These findings suggest that complex quantitative diffusion maps are not essential for clinical stroke imaging.
• Simple DWI techniques are highly effective for early stroke detection.