Abstract
We aimed to investigate the clinicoradiologic determinants of negative diffusion-weighted image (DWI) results in patients with acute cerebral infarction (ACI). The medical records were reviewed of ACI patients. Patients were divided to the DWI positive and negative group. Positive DWI was used as independent variable and patients' clinicoradiologic factors were used as co-variables for multivariate logistic regression analysis. 349 patients received initial cerebral MRI within 72 hours of admission. Lacunar infarction was most common (42.1%) followed by posterior circulation infarction (30.1%) and partial anterior circulation infarction (18.1%). The majority of the patients (72.2%) had an NIHSS score of less than 5 at admission. 316 patients (90.54%) were positive on initial DWI. Patients with smoking, initial SBP ≥ 140 or DBP ≥ 90 mmHg, initial fasting plasma glucose (FPG) ≥7.0 mmol/L, initial MRI from onset of disease >1 d and anterior circulation infarction were liable to show positive DWI. Furthermore, DWI negative patients had significantly lower NIHSS scores (IQR 0,1,2) than DWI positive patients (IQR 1,2,4) (P = 0.000) at two weeks post onset of acute cerebral infarction. In conclusion, multiple clinicoradiologic factors are associated with negative and positive DWI and further delineation of these factors is required in future prospective studies.
Highlights
We aimed to investigate the clinicoradiologic determinants of negative diffusion-weighted image (DWI) results in patients with acute cerebral infarction (ACI)
Positive DWI was used as independent variable and patients’ clinicoradiologic factors were used as co-variables for multivariate logistic regression analysis. 349 patients received initial cerebral magnetic resonance imaging (MRI) within 72 hours of admission
Though a similar proportion of acute cerebral infarction patients had a history of hypertension in the DWI negative and positive group, we found that higher initial blood pressure (BP) ($140/ 90 mmHg) was a risk factor for positive cerebral DWI
Summary
We aimed to investigate the clinicoradiologic determinants of negative diffusion-weighted image (DWI) results in patients with acute cerebral infarction (ACI). Many scholars have found that some acute cerebral infarction patients exhibit negative DWI4–7, which hampers clinical diagnosis. This phenomenon is worthy of further investigation. Rosso et al reviewed the imaging data of patients within 6 hours of of observed symptom onset of anterior circulation infarction by 3.0 T and 1.5 T MR and found the sensitivity and specificity and accuracy of 1.5 T DWI were superior to 3.0 T DWI, suggesting that the intensity of magnetic field of MR instruments impacts on DWI of cerebral infarction during the acute phase[8]. To help to clarify whether the clinicoradiologic factors of patients with acute cerebral infarction had any effect on DWI results during the acute phase, we retrospectively analyzed data of patients with acute cerebral infarction examined using 3.0 T MRI to exclude the disturbance of the intensity of magnetic field
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