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Differentiation of recent and old cerebral infarcts by diffusion-weighted MRI
C Fitzek1, J Tintera, W Müller-Forell
1Department of Neuroradiology, University Hospital, Mainz, Germany.
Abstract:
We performed MRI, including diffusion-weighted imaging, in 15 patients with recurrent strokes with acute ischaemia and at least one old lesion according to the clinical history and/or CT. Routine MRI showed similar signal intensity changes in both situations. Diffusion-weighted images, however, were positive in all acute or subacute infarcts. The high signal of acutely disturbed diffusion due to intracellular oedema could also be identified in small brain stem lesions. Spatial resolution was increased by applying separate gradients in each axis instead of creating anisotropy-independent trace images.
Insights
Diffusion-weighted imaging (DWI) effectively detects acute ischemic stroke, even in small brainstem lesions. This MRI technique shows high signal intensity in areas of disturbed diffusion due to intracellular edema, aiding diagnosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Recurrent strokes pose diagnostic challenges, especially differentiating acute ischemia from older lesions.
- Conventional MRI sequences may not reliably distinguish between acute and chronic stroke findings.
Purpose of the Study:
- To evaluate the utility of diffusion-weighted imaging (DWI) in identifying acute ischemic changes in patients with recurrent strokes.
- To assess the sensitivity of DWI in detecting small infarcts, including those in the brainstem.
Main Methods:
- Magnetic Resonance Imaging (MRI) including DWI was performed on 15 patients with recurrent strokes.
- Patients had confirmed acute ischemia and at least one old lesion.
- Spatial resolution was enhanced using separate gradients per axis.
Main Results:
- Routine MRI showed similar signal intensity changes for both acute and old lesions.
- Diffusion-weighted images (DWI) were positive in all cases of acute or subacute infarcts.
- High signal intensity indicating acutely disturbed diffusion due to intracellular edema was observed even in small brainstem lesions.
Conclusions:
- DWI is a highly sensitive technique for detecting acute ischemic stroke in recurrent cases.
- DWI can identify small infarcts and brainstem lesions with high signal intensity, aiding in early diagnosis.
- Enhanced spatial resolution in DWI improves the detection of subtle ischemic changes.