American Journal of Neuroradiology 21:1434-1440 (8 2000)
© 2000 American Society of Neuroradiology
ARTICLE
False-negative Diffusion-weighted MR Findings in Acute Ischemic Stroke
a From the Departments of Neuroradiology (C.O., R.S., D.D., B.M., C.M.) and Cerebrovascular Emergency (S.C., Y.S., G.R.), Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, Paris, France.
BACKGROUND AND PURPOSE: Lesions associated with acute stroke are often missed by diffusion-weighted imaging (DWI), suggesting that the sensitivity of this technique for detecting acute ischemic stroke may not be as high as initially thought. Our aim was to estimate the rate of false-negative DWI studies in patients with persistent neurologic deficit due to an ischemic stroke and to identify which stroke lesions are most likely to be missed by DWI.
METHODS: We reviewed MR images obtained within 48 hours after stroke onset in 139 patients admitted for symptoms consistent with ischemic stroke in whom the deficit lasted more than 24 hours. Cases of negative initial DWI findings with an ischemic lesion visible on follow-up MR studies and a final diagnosis of arterial ischemic stroke were analyzed in terms of delay between onset of symptoms and initial DWI (MR latency), size and vascular distribution of the lesions, and relationship to findings in patients with positive initial DWI results.
RESULTS: We found eight cases (5.8%) of false-negative initial DWI studies, of which four were positive on initial fluid-attenuated inversion recovery (FLAIR) imaging. Follow-up FLAIR/DWI showed a hyperintensity matching clinical presentation in all eight patients. The mean size of the lesion was 0.19 ± 0.16 cm3. False-negative studies occurred more often in cases of stroke in the posterior (19%) than in the anterior (2%) circulation or when DWI was obtained within 24 hours after symptom onset. Of the six false-negative vertebrobasilar stroke lesions, five were located in the brain stem. In all, 31% of patients with vertebrobasilar ischemic stroke had a false-negative initial DWI study during the first 24 hours.
CONCLUSION: A false-negative DWI study is not uncommon during the first 24 hours of ischemic stroke. Vertebrobasilar stroke should therefore not be ruled out on the basis of early negative DWI, especially when symptoms persist and are suggestive of this diagnosis.
This article has been cited by other articles:
 |
|
 |
|
  J. C. Kattah, A. V. Talkad, D. Z. Wang, Y.-H. Hsieh, and D. E. Newman-Toker HINTS to Diagnose Stroke in the Acute Vestibular Syndrome: Three-Step Bedside Oculomotor Examination More Sensitive Than Early MRI Diffusion-Weighted Imaging Stroke, November 1, 2009; 40(11): 3504 - 3510. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Barrett, Y. H. Ding, D. P. Wagner, D. F. Kallmes, K. C. Johnston, and for the ASAP Investigators Change in Diffusion-Weighted Imaging Infarct Volume Predicts Neurologic Outcome at 90 Days: Results of the Acute Stroke Accurate Prediction (ASAP) Trial Serial Imaging Substudy Stroke, July 1, 2009; 40(7): 2422 - 2427. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Purroy, R. Begue, A. Quilez, G. Pinol-Ripoll, J. Sanahuja, L. Brieva, E. Seto, and M. I. Gil The California, ABCD, and Unified ABCD2 Risk Scores and the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging in TIA Patients Stroke, June 1, 2009; 40(6): 2229 - 2232. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Newman-Toker, J. C. Kattah, J. E. Alvernia, and D. Z. Wang Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis Neurology, June 10, 2008; 70(24_Part_2): 2378 - 2385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.N. Sylaja, S. B. Coutts, A. Krol, M. D. Hill, A. M. Demchuk, and for the VISION Study Group When to Expect Negative Diffusion-Weighted Images in Stroke and Transient Ischemic Attack Stroke, June 1, 2008; 39(6): 1898 - 1900. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Bertrand, C. Oppenheim, C. Lamy, S. Rodrigo, O. Naggara, J.L. Mas, and J.F. Meder Comparison of Optimized and Standard Diffusion-Weighted Imaging at 1.5T for the Detection of Acute Lesions in Patients with Transient Ischemic Attack AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 363 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Khatri, J. Leach, and M. L. Flaherty False-negative diffusion-weighted imaging with lateral medullary infarction Neurology, November 28, 2006; 67(10): E19 - E19. [Full Text] [PDF]
|
|
|
|
|
|
M. J. Alberts, R. E. Latchaw, W. R. Selman, T. Shephard, M. N. Hadley, L. M. Brass, W. Koroshetz, J. R. Marler, J. Booss, R. D. Zorowitz, et al. Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition Stroke, July 1, 2005; 36(7): 1597 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. I. Savitz and L. R. Caplan Vertebrobasilar Disease N. Engl. J. Med., June 23, 2005; 352(25): 2618 - 2626. [Full Text] [PDF]
|
|
|
|
|
|
H. J. Kim, C. G. Choi, D. H. Lee, J. H. Lee, S. J. Kim, and D. C. Suh High-b-Value Diffusion-Weighted MR Imaging of Hyperacute Ischemic Stroke at 1.5T AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 208 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. G. Schulz, D. Briley, T. Meagher, A. Molyneux, and P. M. Rothwell Diffusion-Weighted MRI in 300 Patients Presenting Late With Subacute Transient Ischemic Attack or Minor Stroke Stroke, November 1, 2004; 35(11): 2459 - 2465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Duning, A. Rogalewski, O. Steinstraeter, H. Kugel, A. Jansen, C. Breitenstein, S. Knecht, F. M. Mottaghy, A. Pascual-Leone, and G. Schlaug Repetitive TMS temporarily alters brain diffusion Neurology, June 8, 2004; 62(11): 2144 - 2145. [Full Text]
|
|
|
|
|
|
S. T. Engelter, S. G. Wetzel, E. W. Radue, M. Rausch, A. J. Steck, and P. A. Lyrer The clinical significance of diffusion-weighted MR imaging in infratentorial strokes Neurology, February 24, 2004; 62(4): 574 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Restrepo, G. Pradilla, R. Llinas, and N. J. Beauchamp Perfusion- and Diffusion-Weighted MR Imaging-Guided Therapy of Vertebral Artery Dissection: Intraarterial Thrombolysis through an Occipital Vertebral Anastomosis AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1823 - 1826. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Iancu-Gontard, C. Oppenheim, E. Touze, E. Meary, M. Zuber, J.-L. Mas, D. Fredy, and J.-F. Meder Evaluation of Hyperintense Vessels on FLAIR MRI for the Diagnosis of Multiple Intracerebral Arterial Stenoses Stroke, August 1, 2003; 34(8): 1886 - 1891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Restrepo, R. J. Wityk, M. A. Grega, L. Borowicz Jr, P. B. Barker, M. A. Jacobs, N. J. Beauchamp, A. E. Hillis, and G. M. McKhann Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging of the Brain Before and After Coronary Artery Bypass Grafting Surgery Stroke, December 1, 2002; 33(12): 2909 - 2915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. McKinstry, J. H. Miller, A. Z. Snyder, A. Mathur, G. L. Schefft, C. R. Almli, J. S. Shimony, S. I. Shiran, and J. J. Neil A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns Neurology, September 24, 2002; 59(6): 824 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Sunshine, N. Bambakidis, R. W. Tarr, C. F. Lanzieri, O. O. Zaidat, J. I. Suarez, D. M.D. Landis, and W. R. Selman Benefits of Perfusion MR Imaging Relative to Diffusion MR Imaging in the Diagnosis and Treatment of Hyperacute Stroke AJNR Am. J. Neuroradiol., May 1, 2001; 22(5): 915 - 921. [Abstract] [Full Text]
|
|