Abstract
To the Editor: Barber and colleagues1 are the first to study the important question of whether diffusion-weighted MRI (DWI) is superior to CT in predicting irreversible ischemic tissue damage. They presented the MRI and CT findings obtained from 17 patients within the first 6 hours of symptom onset and used a T2-weighted image at 90 days as gold standard for the final infarct size. According to their table, 15 patients had an infarct on the follow-up MRI. One of 2 patients without infarct on the follow-up MRI was later identified as a nonstroke patient (patient 13). This patient, however, had a positive DWI but a negative CT at baseline, whereas the other had a negative DWI and CT at baseline. I cannot follow the authors saying that “hyperintense lesions on DWI consistent with acute ischemia were seen in all 16 patients with a final diagnosis of stroke, giving a sensitivity and positive predictive value for DWI of 100%.” The predictive values for a ischemic lesion on follow-up …
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