Abstract
To the Editor: We read with great interest the excellent article by Oppenheim et al1 regarding the use of diffusion-weighted imaging (DWI) for the prediction of malignant middle cerebral artery (MCA) infarction. The authors report impressive sensitivity and specificity rates of 100% and 94%, respectively, for the parameter “acute DWI lesion volume >145 cm3” predicting subsequent malignant MCA infarction. Thus, in their study only patients with an initial DWI lesion volume exceeding 145 cm3 went on to develop malignant MCA infarction. The mean time between symptom onset and the DWI measurements was 6.5±3.5 hours (range 2 to 14 hours). However, although we strongly agree that acute DWI lesion volume has the potential to become a powerful predictor of subsequent malignant MCA infarction, we would like to point out that the sensitivity of this parameter may be considerably below 100% in the hyperacute phase (<3 hours). We have recently seen 2 patients presenting within 2 hours of symptom onset, 1 …
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