The use of diffusion-weighted magnetic resonance imaging to identify infarctions in patients with minor strokes

doi:10.1053/jscd.2000.0090070

Journal of Stroke and Cerebrovascular Diseases

Volume 9, Issue 2, March–April 2000, Pages 70-75

https://doi.org/10.1053/jscd.2000.0090070 Get rights and content

Background: Diffusion-weighted magnetic resonance imaging (DWI) shows cerebral infarction within minutes of its occurrence, but its value in clinical management after the stroke is less clear. We evaluated DWI scans in patients with minor strokes to determine whether DWI was helpful in identifying the stroke lesion and how long after the stroke could DWI still identify the lesion. Method: Patients admitted to our hospital with symptoms of a lacunar or minor cortical or posterior fossa stroke underwent T2 and proton density magnetic resonance imaging (MRI) of the brain, followed by DWI on a 1.5 Tesla Siemens scanner. The individual MR sequence images were examined (blind to each other and clinical information) to identify any recent infarction. Results: In 40 subjects (13 lacunes, 17 cortical, 5 posterior circulation infarctions, 2 transient ischemic attacks [TIAs] and 3 non-stroke), DWI scans showed the recent infarction clearly (even tiny ones) in 24 subjects (60%), in 12 of whom no infarction was visible on the T2 or proton density images. DWI also correctly excluded infarction in patients subsequently found not to have had a stroke. The diffusion abnormality was visible for up to 23 days after the stroke. Conclusion: DWI is useful for pinpointing the site of small infarctions that are either not visible or not distinguishable from previous lesions on T2 or proton density MRI, up to at least 3 weeks after the stroke. This may assist with planning further management of the stroke. The clinical use of DWI should not be restricted to just the first few hours after the stroke.

References (19)

KohnoK et al.
Relationship between diffusion-weighted MR images, cerebral blood flow, and energy state in experimental brain infarction
Magn Reson Imag
(1995)
ArmitagePA et al.
Diffusion anisotropy measurements in ischaemic stroke of the human brain
MAGMA
(1998)
BamfordJ et al.
Classification and natural history of clinically identifiable subtypes of cerebral infarction
Lancet
(1991)
GassA et al.
Rapid recovery from left hemiplegia
Lancet
(1997)
LövbladK-O et al.
Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome
Ann Neurol
(1997)
WarachS et al.
Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: A preliminary analysis
J Cereb Blood Flow Metab
(1996)
RordorfG et al.
Regional ischemia and ischemic injury in patients with acute middle cerebral artery stroke as defined by early diffusionweighted and perfusion-weighted MRI
Stroke
(1998)
NageshV et al.
Time course of ADC_w changes in ischemic stroke: Beyond the human eye
Stroke
(1998)
van EverdingenKJ et al.
Diffusion-weighted magnetic resonance imaging in acute stroke
Stroke
(1998)

There are more references available in the full text version of this article.

Cited by (14)

Diagnostic benefit of high b-value computed diffusion-weighted imaging in acute brainstem infarction
2022, Journal of Neuroradiology
Citation Excerpt :
Consequently, it is crucial for the therapeutic process to clearly detect and delineate ischemic lesions. Due to its high sensitivity and specificity, diffusion- weighted imaging (DWI) has become the gold standard for detection and extent estimation of ischemic brain infarction.2,4–6 So, a sensitivity of up to 96–98% was reported in the literature for all ischemic strokes.
Diffusion-weighted imaging (DWI) is a cornerstone in diagnostic of ischemic stroke. The aim of this study was to investigate the usefulness of high-b-value computed DWI (c-DWI) in comparison to standard DWI in patients with acute brainstem infarction.
56 patients with acute brainstem infarction were retrospectively analysed by two readers. DWI was obtained with the b-values 0, 500 and 1000 s/mm² on either a 1.5 or 3 T magnetic resonance imaging (MRI) scanner. c-DWI was calculated with a monoexponential model with high b-values 2000, 3000, 4000 and 5000 s/mm². All c-DWI series with high-b-values were compared to the standard DWI sequence at b-value of 1000 s/mm² in terms of image artifacts, lesion extent and contrast.
There was no statistically significant difference between 1.5 and 3 T MRI regarding the measured ischemic lesion size. There were no statistically significant differences between the ischemic lesion sizes on DWI at b-values of 1000 s/mm² and on c-DWI at higher b-values. Overall, the contrast between the lesion and the surrounding normal areas improved with increasing b-value on the isotropic DWIs: maximum at b = 5000, followed by that at b 2000 and b 1000 s/mm², in order. The best relation between artifacts and lesion contrast was identified for b 2000 s/mm².
High b-value DWI derived from c-DWI has a higher visibility for ischemic brainstem lesions compared to standard DWI without additional time cost. The b-2000 image is recommended to use in clinical routine, higher b-value images lead to more imaging artifacts, which might result in misdiagnosis.
Risk factors for small cortical infarction on diffusion-weighted magnetic resonance imaging in patients with acute ischemic stroke
2011, Journal of Stroke and Cerebrovascular Diseases
Diffusion-weighted magnetic resonance imaging (MRI) is sensitive for detecting acute ischemic lesions. The present study evaluated risk factors associated with small cortical infarction (SCI) on diffusion-weighted MRI. We analyzed 123 patients with acute ischemic stroke retrospectively. We defined an SCI as a cortical lesions <1.5 cm in diameter detected by diffusion-weighted MRI. Risk factors and comorbidities included hypertension, hypercholesterolemia, diabetes mellitus, cigarette smoking, potential cardiac sources of embolism, carotid disease, and coagulopathy. Carotid disease was defined as >50% stenosis or occlusion in the internal carotid artery, detected by carotid ultrasonography. In addition, we analyzed plasma levels of coagulation and fibrinolysis markers. We also compared carotid disease, potential cardiac sources, and coagulopathy among localization of SCI. SCI was identified in 22.8% of patients with acute ischemic stroke. Carotid disease (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.7-11.42; P = .002) and coagulopathy (OR = 6.8; 95% CI = 1.33-35.17; P = .02) were found to be independent risk factors for SCI. SCI with carotid disease was not associated with bilateral and multiple territorial lesions, whereas SCI with coagulopathy was associated with bilateral lesions. No borderzone lesions were found in SCI patients with cardiac sources. Our findings suggest that carotid disease and coagulopathy are independent risk factors for SCI. Localization of SCI varies depending on the underlying diseases.
Stroke
2003, Lancet
Citation Excerpt :
Some severe infarcts do not appear for several days, though the proportion of infarcts not seen at all is much smaller than with CT. In clinical practice, as well as in research, DWI is especially useful in patients with minor stroke symptoms (the group in whom CT or T2 MR is least likely to show the lesion; figure 6).50 It is also useful in patients with suspected recurrent stroke (to discriminate from worsening neurological deficit due to intercurrent illness) and to identify multiple infarcts in different arterial territories, which suggest cardioembolic stroke (figure 7).
Stroke is a major public-health burden worldwide. Prevention programmes are essential to reduce the incidence of stroke and to prevent the all but inevitable stroke epidemic, which will hit less developed countries particularly hard as their populations age and adopt lifestyles of the more developed countries. Efficient, effective, and rapid diagnosis of stroke and transient ischaemic attack is crucial. The diagnosis of the exact type and cause of stroke, which requires brain imaging as well as traditional clinical skills, is also important when it will influence management. The treatment of acute stroke, the prevention and management of the many complications of stroke, and the prevention of recurrent stroke and other serious vascular events are all improving rapidly. However, stroke management will only be most effective when delivered in the context of an organised, expert, educated, and enthusiastic stroke service that can react quickly to the needs of patients at all stages from onset to recovery.
Predicting the Severity of Neurological Impairment Caused by Ischemic Stroke Using Deep Learning Based on Diffusion-Weighted Images
2022, Journal of Clinical Medicine
Value of combination of standard axial and thin-section coronal diffusion-weighted imaging in diagnosis of acute brainstem infarction
2019, Open Access Macedonian Journal of Medical Sciences
Sagittal diffusion-weighted imaging in preventing the false-negative diagnosis of acute brainstem infarction: Confirmation of the benefit by anatomical characterization of false-negative lesions
2019, Surgical Neurology International

View all citing articles on Scopus

^*: Supported by the Scottish Office Chief Scientist's Office and performed as part of the UK Medical Research Council Clinical Research Initiative in Clinical Neurosciences.

View full text

The use of diffusion-weighted magnetic resonance imaging to identify infarctions in patients with minor strokes*

Magn Reson Imag

MAGMA

Lancet

Lancet

Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome

Ann Neurol

Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: A preliminary analysis

J Cereb Blood Flow Metab

Regional ischemia and ischemic injury in patients with acute middle cerebral artery stroke as defined by early diffusionweighted and perfusion-weighted MRI

Stroke

Time course of ADCw changes in ischemic stroke: Beyond the human eye

Stroke

Diffusion-weighted magnetic resonance imaging in acute stroke

Stroke

Time course of ADC_w changes in ischemic stroke: Beyond the human eye