Role of Diffusion Weighted Imaging in Enhancing MR Imaging in Recent Is-chemic Stroke Patients

Abstract

Stroke is a common cause of admission to hospitals, and imaging in acute stroke is necessary to differentiate ischemic from haemorrhagic stroke and to exclude other diagnoses. This study aimed to evaluate the role of diffusion-weighted magnetic resonance imaging (DW MRI) in the diagnosis of recent cerebral ischemic infarction in a consecutive series of patients with symptoms of acute stroke and its feasibility as first-line imaging for those patients. We report our results with DWI and apparent diffusion coefficient (ADC) mapping comparing the sensitivity of DWI with that of conventional T2 weighted and fluid-attenuated inversion recovery (FLAIR) MRI. A Prospective audit of 87 patients with clinically suspected recent stroke referred for imaging over a consecutive 20-week period was done. The data collected included patient age, time from onset of symptoms, and clinical presentation. DWI echo planar, FLAIR, and turbo spin-echo T2-weighted MRI were performed, and ADC maps were generated. Conventional MR images were assessed before DW images. DWI was considered positive for the diagnosis of new arterial stroke whenever hyperintensities with reduced ADC values were observed, and the site of infarct detected on the images was included in patients’ data. The results were 47 patients had a final diagnosis of recent ischemic cerebral infarct. With DWI, 98% of the ischemic lesions were detected, whereas with FLAIR, only 70% were detected, and with T2-weighted images, 66% of lesions were found. There was a significant difference between the results of ischemic infarcts’ detection on DWI and T2-w/FLAIR in relation to time from onset (P value = .012). In this study, I was able to image 68% (60 of 87) of the referred suspected stroke patients with DW MRI within 48 hours and 39 patients (45%) within 24 hours of the onset of symptoms. DW MRI showed high sensitivity and superiority over conventional T2 and FLAIR imaging for the detection of acute ischemic lesions in stroke patients; it also proved quite feasible as a first-line of neuroimaging.