American Journal of Neuroradiology, Vol 19, Issue 6 1061-1066, Copyright © 1998 by American Society of Neuroradiology
ARTICLES |
Clinical experience with diffusion-weighted MR in patients with acute stroke
KO Lovblad, HJ Laubach, AE Baird, F Curtin, G Schlaug, RR Edelman and S Warach
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA.
PURPOSE: Our purpose was to evaluate the clinical efficacy, sensitivity, and specificity of echo-planar diffusion-weighted MR imaging in patients with acute infarction. METHODS: We retrospectively analyzed 194 cases of acute ischemic stroke diagnosed clinically within 24 hours of onset and studied with echo-planar diffusion-weighted MR imaging. Examinations were considered to be positive for infarction when an increase in signal was noted on images acquired at a high b value but absent on images with a low b value. A final clinical diagnosis of acute stroke was used as the standard of reference. A subset of 48 patients scanned within 6 hours was also analyzed. RESULTS: Diffusion-weighted MR imaging studies were positive in 133 of 151 cases of infarction (88% sensitivity) and negative in 41 of 43 cases with no infarction (95% specificity). Two cases identified as positive on diffusion-weighted images had nonischemic diagnoses (1.5% false-positive rate). Diffusion-weighted imaging had a positive predictive value of 98.5% and a negative predictive value of 69.5%. Use of T2-weighted sequences as well as diffusion-weighted imaging produced no false-positive findings. Of the negative scans, 69.5% corresponded to transient ischemic attacks or infarcts (mostly small brain stem infarcts). When only cases scanned within 6 hours of onset were considered, the sensitivity rose to 94% and the specificity to 100%. CONCLUSION: Despite bias due to dependence between diffusion-weighted imaging and the final diagnosis, this analysis suggests high sensitivity and specificity for echo-planar diffusion-weighted imaging in the diagnosis of acute cerebral infarction, although negative scans did not rule out an ischemic pathogenesis.
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W. T. C. Yuh, T. Ueda, M. White, M. E. Schuster, and T. Taoka The Need for Objective Assessment of the New Imaging Techniques and Understanding the Expanding Roles of Stroke Imaging AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1779 - 1784. [Full Text]
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J. R. Reichenbach, J. Röther, L. Jonetz-Mentzel, M. Herzau, A. Fiala, C. Weiller, and W. A. Kaiser Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1842 - 1850. [Abstract] [Full Text]
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D. Lefkowitz, M. LaBenz, S. R. Nudo, R. E. Steg, and J. M. Bertoni Hyperacute Ischemic Stroke Missed by Diffusion-Weighted Imaging AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1871 - 1875. [Abstract] [Full Text]
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P. Y-K. Wang, P. B. Barker, R. J. Wityk, A. M. Ulug, P. C. M. van Zijl, and N. J. Beauchamp Diffusion-Negative Stroke: A Report of Two Cases AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1876 - 1880. [Abstract] [Full Text]
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P. A. Barber, D. G. Darby, P. M. Desmond, R. P. Gerraty, Q. Yang, T. Li, D. Jolley, G. A. Donnan, B. M. Tress, and S. M. Davis Identification of Major Ischemic Change : Diffusion-Weighted Imaging Versus Computed Tomography Stroke, October 1, 1999; 30(10): 2059 - 2065. [Abstract] [Full Text] [PDF]
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B. Desprechins, T. Stadnik, G. Koerts, W. Shabana, C. Breucq, and M. Osteaux Use of Diffusion-Weighted MR Imaging in Differential Diagnosis Between Intracerebral Necrotic Tumors and Cerebral Abscesses AJNR Am. J. Neuroradiol., August 1, 1999; 20(7): 1252 - 1257. [Abstract] [Full Text]
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J. L. Sunshine, R. W. Tarr, C. F. Lanzieri, D. M. D. Landis, W. R. Selman, and J. S. Lewin Hyperacute Stroke: Ultrafast MR Imaging to Triage Patients prior to Therapy Radiology, August 1, 1999; 212(2): 325 - 332. [Abstract] [Full Text]
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J. O. Karonen, R. L. Vanninen, Y. Liu, L. Ostergaard, J. T. Kuikka, J. Nuutinen, E. J. Vanninen, P. L. K. Partanen, P. A. Vainio, K. Korhonen, et al. Combined Diffusion and Perfusion MRI With Correlation to Single-Photon Emission CT in Acute Ischemic Stroke : Ischemic Penumbra Predicts Infarct Growth Stroke, August 1, 1999; 30(8): 1583 - 1590. [Abstract] [Full Text] [PDF]
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T. Ueda, W. T. C. Yuh, J. E. Maley, J. P. Quets, P. Y. Hahn, and V. A. Magnotta Outcome of Acute Ischemic Lesions Evaluated by Diffusion and Perfusion MR Imaging AJNR Am. J. Neuroradiol., June 1, 1999; 20(6): 983 - 989. [Abstract] [Full Text]
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M. G. Lansberg, D. C. Tong, A. M. Norbash, M. A. Yenari, and M. E. Moseley Intra-Arterial rtPA Treatment of Stroke Assessed by Diffusion- and Perfusion-Weighted MRI Stroke, March 1, 1999; 30(3): 678 - 680. [Abstract] [Full Text] [PDF]
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F. E. Lecouvet, T. P. J. Duprez, J. M. Raymackers, A. Peeters, and G. Cosnard Resolution of early diffusion-weighted and FLAIR MRI abnormalities in a patient with TIA Neurology, March 1, 1999; 52(5): 1085 - 1085. [Abstract] [Full Text]
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