Diffusion-weighted Imaging Group Research Articles

Management of patients with diffusion-weighted imaging-negative acute ischemic stroke: Retrospective analysis of 47 consecutive patients

BackgroundFew studies with a limited number of patients focused on the outcomes of patients with diffusion-weighted imaging (DWI)-negative acute ischemic stroke (AIS) after intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). MethodsThis retrospective observational, single-center study included all consecutive patients admitted for AIS involving the anterior circulation and treated with IVT and/or EVT between January 1, 2015 and December 31, 2023. The collected data were used to identify the characteristics of patients with negative DWI and to compare outcomes in patients with negative and positive DWI. ResultsAmong the 1210 patients included, 47 (3.9 %) had negative (DWI-negative group) and 1163 had increased DWI signal (DWI-positive group). In the DWI-negative group, the mean age was 69 years (SD=19.4), 55.3 % were men, and 27 (57.4 %) had a large vessel occlusion. Thirty eight (80.9 %) were treated with IVT alone, 7 (14.9 %) with EVT alone, and 2 (4.3 %) with both. Fluid attenuated inversion recovery (FLAIR) sequences were the most sensitive to detect predictive factors of cerebral ischemia, such as vessel thrombosis and the spaghetti sign that were found in 68.1 % and 83 %, of patients, respectively. Oxyhemoglobin-sensitive (T2*) and susceptibility-weighted angiography (SWAN) sequences were less sensitive: vessel thrombosis and the brush sign were detected in 55.3 % and 19.1 % of patients, respectively. Comparison of the two DWI groups showed that M2 occlusion was more frequent (31.9 % vs 13 %, p<0.001) and M1 occlusion rarer (19.1 % vs 36 %, p<0.02) in the DWI-negative than DWI-positive group. At admission, the median National Institutes of Health Stroke Scale score was lower in the DWI-negative than DWI-positive group (2 vs 6, p=0.0001), but the median symptom onset-to-MRI time was similar in both groups (108 vs 111 min, p=0.88). ConclusionsIn patients with DWI-negative AIS, symptoms are less severe. Large vessel occlusions, notably in the M2 segment, are more distal at the expense of the M1 segment of MCA. The spaghetti sign remains the most predictive feature of AIS that should be specifically searched in the absence of DWI lesions.

Comparison of ZOOMit-DWI sequence and conventional DWI sequence in endometrial cancer.

Magnetic resonance diffusion-weighted imaging (DWI) has important clinical value in diagnosis and curative effect evaluation on endometrial carcinoma. How to improve the detection rate of endometrial small lesions by DWI is the research focus of MRI technology. This study aims to analyze the image quality of small field MRI ZOOMit-DWI sequence and conventional single-shot echo-planar imaging (SS-EPI) DWI sequence in the scanning of endometrial carcinoma, and to explore the clinical value of ZOOMit-DWI sequence. A total of 37 patients with endometrial carcinoma diagnosed by operation and pathology in the Second Xiangya Hospital of Central South University from July 2019 to May 2021 were collected. All patients were scanned with MRI ZOOMit-DWI sequence and SS-EPI DWI sequence before operation. Two radiologists subjectively evaluated the anatomical details, artifacts, geometric deformation and focus definition of the 2 groups of DWI images. At the same time, the signal intensity were measured and the signal-to-noise ratio (SNR), contrast to noise ratio (CNR), and apparent diffusion coefficient (ADC) of the 2 DWI sequences were calculated for objective evaluation. The differences of subjective score, objective score and ADC value of the 2 DWI sequences were analyzed. The SNR of the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (301.96±141.85 vs 94.66±41.26), and the CNR of the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (185.05±105.45 vs 57.91±31.54, P<0.05). There was no significant difference in noise standard deviation between the ZOOMit-DWI group and the SS-EPI DWI group (P>0.05). The subjective score of anatomical detail and focus definition in the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (both P<0.05). The subjective score of artifacts and geometric deformation of ZOOMit-DWI group was significantly lower than that of the SS-EPI DWI group (both P<0.05). ADC had no significant difference between the ZOOMit-DWI group and the SS-EPI DWI group (P>0.05). The image quality of ZOOMit-DWI is significantly higher than that of conventional SS-EPI DWI. In the MRI DWI examination of endometrial carcinoma, ZOOMit-DWI can effectively reduce the geometric deformation and artifacts of the image, which is more conducive to clinical diagnosis and treatment.

Systolic blood pressure and recurrent stroke in patients with different lesion patterns on diffusion weighted imaging.

Little is known about the relationship between baseline systolic blood pressure (SBP) and subsequent clinical events in patients with different lesion patterns on diffusion weighted imaging (DWI). We analyzed the Acute Non‐disabling Cerebrovascular Events (CHANCE) trial dataset. Patients were categorized into negative DW imaging (no detectable lesions), lacunar infarction (single lesion ≤15 mm) and non‐lacunar infarction (single lesion >15 mm or multiple lesions) based on lesion patterns on DWI. The primary outcome was recurrent stroke within 90 days. Cox proportional hazards models were used to assess the association between SBP levels and stroke outcomes in patients with different lesion patterns. A total of 1089 patients were analyzed. We found 258 cases (23.7%) with negative DW imaging, 392 (36.0%) with lacunar infarction and 439 (40.3%) with non‐lacunar infarction. Patients with non‐lacunar infarction had the highest incidence of stroke at 90‐day (P < .001). In non‐lacunar infarction group, compared with SBP < 160 mmHg, patients with SBP ≥ 160 mmHg had significantly higher risk of 90‐day recurrent stroke (20.3% vs. 10.7%; adjusted hazard ratio 1.81, 95% confidence interval 1.09–3.00). No significant association was found between SBP and clinical outcomes in patients with negative DWI and lacunar stroke groups. The result at 1 year was similar as at 90‐day. Therefore, non‐lacunar infarction, the most common lesion pattern in CHANCE study, had the highest risk of recurrent stroke and combined vascular events both in 90 days and 1 year. High baseline SBP was significantly associated with increased risk of short‐ and long‐term recurrent strokes in patients with non‐lacunar infarction.

Distribution and prognosis of acute ischaemic stroke with negative diffusion-weighted imaging

Background and purposeTo examine the distribution and prognosis among patients with diffusion-weighted imaging (DWI)-negative acute ischaemic stroke (AIS) and explore the differences between mild (National Institute of Health Stroke Scale...

Outcomes of Symptomatic Anterior Large Vessel Occlusion by Initial Imaging Assessment Using Diffusion‐Weighted Imaging Versus Noncontrast Computed Tomography

Background We aimed to compare outcomes after stroke due to anterior circulation large vessel occlusion with initial imaging assessments using diffusion‐weighted imaging (DWI) or noncontrast computed tomography (NCCT). Methods Among 2399 patients with large vessel occlusion stroke in a prospective, multicenter registry, patients with (1) prestroke modified Rankin Scale scores 0 to 1, (2) occlusion of the internal carotid artery or M1 segment of the middle cerebral artery, and (3) onset‐to‐hospital‐arrival time &lt;6 hours were included. The primary effectiveness outcome was good functional outcome, defined as modified Rankin Scale scores 0 to 2 at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. Intergroup biases were accounted for by mixed‐effects multivariable modeling and inverse probability of treatment weighting. Results A total of 343 patients (130 women [37.9%]; median age, 74 years [interquartile range, IQR, 66–82 years]) were analyzed. DWI‐based assessment was performed in 217 patients, and NCCT‐based assessment was performed in 126 patients. The DWI group showed a lower baseline National Institutes of Health Stroke Scale score ( P &lt;0.01) and lower Alberta Stroke Program Early CT Score ( P &lt;0.01) than the NCCT group. Frequency of endovascular therapy was lower in the DWI group (71.9%) than in the NCCT group (84.1%; P &lt;0.01). Median hospital‐arrival‐to‐arterial‐puncture time was 55 minutes (IQR, 40–77.5 minutes) in the DWI group and 55 minutes (IQR, 35–80 minutes) in the NCCT group ( P =0.89), with similar rates of successful recanalization (77.6% versus 76.4%, respectively; P =0.88). Frequency of good functional outcome was 47.0% in the DWI group and 41.3% in the NCCT group (adjusted odds ratio, 1.32; 95% CI, 0.49–3.55). Symptomatic intracranial hemorrhage was encountered in 2.8% in the DWI group and 1.6% in the NCCT group ( P =0.71). Conclusions Potential difference in accuracy of ischemic damage assessment between the 2 modalities did not seem to affect outcomes of anterior circulation large vessel occlusion stroke. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02419794.

Diffusion-Weighted Imaging Combined with Cervical Vascular Ultrasound in the Elderly Patients with Multiple Cerebral Infarction.

Objective This study is aimed at evaluating the diagnostic value of diffusion-weighted imaging combined with cervical vascular ultrasound in the elderly patients with multiple cerebral infarctions and at demonstrating whether the diagnostic value is affected by the history of diabetes. Methods From January 2020 to November 2021, the case data of 30 elderly patients with multiple cerebral infarction diagnosed in our hospital were included. Diffusion-weighted magnetic resonance imaging (DWI) and cervical vascular ultrasound (CAU) were performed, respectively. The diagnosis rates of the simple diffusion-weighted imaging group, the simple cervical vascular ultrasound group, and the diffusion-weighted imaging combined with cervical vascular ultrasound group were compared. Results The median onset time of 30 patients was 26.5 (4.75, 43.0) hours. There were 10 hyperacute patients and 20 acute patients. The proportion of diagnosable patients in the diffusion-weighted imaging group was 83.8% (25/30), which was lower than the proportion of diagnosable patients in the diffusion-weighted imaging combined with cervical vascular ultrasound group, which was 90% (27/30). The difference was statistically significant (χ2 = 16.667; P < 0.001). The ratio of diagnosable patients in the cervical vascular ultrasound group alone was 66.7% (20/30), which was lower than 90% (27/30) in the diffusion-weighted imaging combined with cervical vascular ultrasound group. The difference was statistically significant (χ2 = 6.7; P = 0.010). In the hyperacute phase, the proportion of diagnosable patients in the diffusion-weighted imaging combined with cervical vascular ultrasound group was higher than that in the diffusion-weighted imaging group alone (χ2 = 5.833; P = 0.016) and the cervical vascular ultrasound group alone (χ2 = 2.500; P = 0.004). In the acute phase, the proportion of diagnosable patients in the diffusion-weighted imaging combined with cervical vascular ultrasound group was also higher those that in the diffusion-weighted imaging group alone (χ2 = 9.474; P = 0.002) and the cervical vascular ultrasound group alone (χ2 = 3.158; P = 0.006). The diagnostic accuracy of diffusion-weighted imaging combined with cervical vascular ultrasound was not significantly different between patients with history of diabetes and without history of diabetes (χ2 = 1.014; P = 0.314) Conclusion The combined application of diffusion-weighted imaging and cervical vascular ultrasound has important value in improving the diagnosis rate of multiple cerebral infarction in the elderly, regardless of diabetes history, and it is worthy of clinical application.

Value of diffusion-weighted imaging in preoperative evaluation and prediction of postoperative supplementary therapy for patients with cervical cancer.

BackgroundWith the continuous progress of medical imaging technology, evaluation of cervical cancer is increasingly dependent on imaging methods. Diffusion-weighted imaging (DWI) plays an important role, and apparent diffusion coefficient (ADC) value is a unique quantitative parameter in the research of cervical cancer.MethodsIn this prospective study, a total of 273 patients diagnosed with stage IB1 to IIIC1 cervical cancer based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging guidelines who underwent pelvic 3.0T magnetic resonance imaging (MRI), including MRI and DWI, were enrolled, and the diagnostic value of preoperative staging of cervical cancer was compared between the MRI and DWI groups. The DWI group was used to explore the potential association of mean ADC (ADCmean) with different pathological characteristics and receiver operating characteristic (ROC) curves of ADCmean generated to predict the appropriate postoperative supplementary therapy.ResultsThe diagnostic coincidence rate of DWI was higher than that of MRI in preoperative staging of cervical cancer (χ2, P<0.05) and determined as stages IB1 + IB2 + IIA1 (90.91%), IB3 + IIA2 (93.48%), and IIIC1p (95.16%). The DWI staging results were consistent with postoperative pathological staging (Kappa value =0.865, P<0.001). We observed significant differences in ADCmean values in relation to pathological type, histological grade, depth of stromal infiltration, tumor diameter, lymphovascular invasion, and pelvic lymph node metastasis of cervical cancer (all P<0.05). The area under the ROC curve (AUC) was 0.815, with the best predictive value for postoperative supplementary therapy in cervical cancer (sensitivity 80.0%, specificity 74.0%) at ADCmean of 0.910×10−3 mm2/s.ConclusionsThe DWI is a useful tool for preoperative evaluation of cervical cancer. In local cervical lesions, ADCmean varies in relation to different clinicopathological characteristics and a reference index of <0.910×10−3 mm2/s can be effectively applied to predict the need for postoperative supplementary therapy.

Preoperative Imaging Risk Findings for Postoperative New Stroke in Patients With Acute Type A Aortic Dissection.

Background: Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD.Methods: From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (–) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke.Results: The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (–) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (–) cohort.Conclusions: Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke.

High resolution diffusion-weighted imaging with readout segmentation of long variable echo-trains for determining myometrial invasion in endometrial carcinoma

BackgroundWe assessed the image quality of endometrial cancer lesions by readout segmentation of long variable echo-trains (RESOLVE) diffusion-weighted imaging (DWI) compared with that by single-shot echo-planar imaging (SS-EPI) DWI, aimed to explore the value of RESOLVE DWI for determining myometrial invasion and clinical stage in endometrial cancer.Materials and methodsFrom April 2017 to March 2018, a total of 30 endometrial cancer patients (mean age 52.8 ± 9.0 years), who had undergone RESOLVE DWI and SS-EPI DWI, were included in the study. The image quality of endometrial carcinoma by two kinds of DWI scanning methods was compared qualitatively and quantitatively. The Spearman rank correlation test was used to assess the correlation of qualitative image quality scores between two readers. The accuracy of two DWI methods in detecting myometrial invasion and staging of endometrial carcinoma was calculated according to postoperative pathological results. The indexes were analyzed including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).ResultsThe qualitative score of RESOLVE DWI group was superior to SS-EPI DWI group in every aspect of five aspects (all P < 0.001). Interobserver agreement of depiction was good or excellent in two DWI sequences. Signal to noise ratio and contrast to noise ratio values in RESOLVE DWI group were both higher than those in SS-EPI DWI group (P<0.001). No statistical difference of apparent diffusion coefficient value was observed between two DWI groups (P = 0.261). The specificity, accuracy, PPV, and NPV of estimating myometrial invasion by RESOLVE DWI in three cases (intramucosal lesion, <50% superficial invasion and ≥ 50% deep invasion) were all higher than those by SS-EPI DWI for endometrial carcinoma. Especially RESOLVE DWI was valuable in judging <50% superficial invasion (95%CI:0.586, 0.970). No significant difference in accuracy staging was between the two DWI groups (P = 0.125).ConclusionRESOLVE DWI can provide higher quality images of endometrial carcinoma than SS-EPI DWI. The high-quality images are helpful for precise assessment of myometrial invasion in endometrial cancer.

Effectiveness of diffusion-weighted imaging in predicting cervical lymph node metastasis in head and neck malignancies

The aim of this study was to evaluate the effectiveness of diffusion-weighted imaging (DWI) in predicting cervical lymph node metastasis in head and neck malignancies. Of the 67 patients with head and neck malignancies included in the study, 36 patients (the DWI group) underwent DWI examination with magnetic resonance imaging (MRI) of the cervical lymph nodes, and 31 patients (the conventional MRI group) underwent MRI only. Radiologists classified the lymph nodes as "metastatic" or "benign" in the DWI group by using MRI features and the apparent diffusion coefficients (ADCs) calculated from DWI, and in the conventional MRI group with MRI only. Histopathologic diagnosis of the nodes was the gold standard. The average ADC value of metastatic lymph nodes was significantly lower than that of benign lymph nodes (P=.020). An optimal threshold ADC value effectively distinguished the ADCs of metastatic versus benign lymph nodes (P=.003). Diagnostic performance was significantly better in the DWI group (P=.044), with significantly higher values for sensitivity, positive predictive value, and area under the receiver operating characteristic curve (P ≤ .039). ADC is effective in distinguishing metastatic lymph nodes from benign lymph nodes. The addition of ADC values to the morphologic evaluation of MRI results in significantly better diagnostic outcomes compared with evaluation of MRI alone.

Quick Brain Magnetic Resonance Imaging With Diffusion-Weighted Imaging as a First Imaging Modality in Pediatric Stroke

BackgroundDiagnostic delay hinders management of pediatric arterial ischemic stroke. Quick brain MRI with diffusion-weighted imaging sequences may provide a rapid diagnosis without the ionizing radiation of a computed tomography (CT) scan. MethodsThis was a single center retrospective chart review of children one month to 18 years old with acute arterial ischemic stroke hospitalized between January 2010 and January 2017. We evaluated sensitivity and the time to diagnostic study based on the first imaging study (CT or quick brain MRI with diffusion-weighted imaging). ResultsTwenty-five patients were included. Eleven patients (44%) were initially assessed with CT, 10 (40%) with quick brain MRI with diffusion-weighted imaging, and four (16%) with a full MRI. Compared with children undergoing CT, children with quick brain MRI with diffusion-weighted imaging as first study were younger (5.8 versus 14.1 years, P < 0.001) and were more likely to be hospitalized at stroke onset (70% versus 18.2%, P = 0.03). Quick brain MRI with diffusion-weighted imaging was more sensitive for ischemia than CT (100% versus 27.3%). The median time from presentation to diagnostic imaging was 4.3 hours, with no differences between CT and quick brain MRI with diffusion-weighted imaging groups, although the quick brain MRI with diffusion-weighted imaging group had a shorter median time from first imaging to diagnostic imaging (P = 0.002). There were no significant missed findings on quick brain MRI with diffusion-weighted imaging. ConclusionsQuick brain MRI with diffusion-weighted imaging was more sensitive than CT for detecting ischemia and may be considered as the first study for some children presenting with suspected arterial ischemic stroke.

Initial diffusion-weighted MRI and long-term neurologic outcomes in charcoal-burning carbon monoxide poisoning

Context: This study assessed the results of diffusion-weighted imaging (DWI) at presentation for acute charcoal-burning carbon monoxide (CO) poisoning and investigated whether the initial DWI results can predict long-term neurologic outcomes.Methods: The study included 128 patients who suffered from CO poisoning after burning charcoal and underwent DWI. These patients were divided into two groups based on imaging results: a normal DWI group and an abnormal DWI group. Data regarding clinical courses and long-term neurologic outcomes (persistent severe neurologic sequelae) were collected and compared.Results: The rate of abnormal DWI findings at presentation was 23.4%, and the most common site of abnormalities was the globus pallidus. All lesions in abnormal DWI had decreased apparent diffusion coefficient (ADC) values. The long-term neurologic state was assessed at a median follow-up of 19.5 months, and the frequency of poor long-term neurologic outcome was significantly higher in the abnormal DWI group (40.0% in the abnormal DWI group vs. 1.0% in the normal DWI group; p < .001). Abnormal DWI (odds ratio [OR]): 31.3, 95% confidence interval [CI]: 2.5–397) and old age (OR 1.1, 95% CI: 1.001–1.13) were independent factors for poor long-term neurologic outcomes, whereas the Glasgow Coma Scale score at presentation (OR: 0.7, 95% CI: 0.6–0.9) was negatively associated with the risk of poor long-term neurologic outcome.Conclusions: In cases involving CO poisoning due to charcoal burning, DWI at presentation may help predict the long-term neurological outcome after discharge.

Application of pelvis multi-parameter MRI diagnostic model for the diagnosis of prostate cancer in early stage

Objective To explore the effectiveness and clinical value of pelvic multi-parameter MRI diagnostic model in the diagnosis of prostate cancer in early stage. Methods the clinical data of 260 patients whose PSA<20μg/L were Collected from October 2013 to November 2014 in Beijing hospital. All the patients were first evaluated by MRI diagnostic model which consists of the imaging presentation from T2 weighted imaging (T2WI), Diffusion weighted imaging (DWI), and the both together in order to acquire the likelihood of prostate cancer, and followed by systemic prostate biopsy in order to verify the diagnosis above. Results Among 260 patients, a total of 107 cases of patients were diagnosed prostate cancer via trans-rectal fine needle biopsy, the positive rate was 41.15%. the scores of T2WI, DWI and T2WI + DWI significantly correlated with the rate of positive biopsy, from 6.7% to 65.6%, 14.4% to 60.7% and 13.5% to 55.9% respectively, P<0.05. Receiver Operating Characteristic (ROC) curves were made based on the T2WI, DWI and T2WI + DWI diagnostic model, whose Area Under Curve(AUC)s were 0.651 ± 0.034, 0.744 ± 0.031 and 0.728 ± 0.031 respectively. To take the 1 score in the T2WI model as the baseline, from 2 score to 5 score, the risk of prostate cancer incidence was 2.933, 3.882, 5.005and 7.944 times respectively. To take the 1 score in the DWI model as the as the baseline, from 2 score to 5 score, the risk of prostate cancer incidence was 2.233, 8.136, 8.614 and 18.313 times respectively. In the T2WI + DWI group, the risk of incidence was 1.333, 6.228, 8.305 and 9.996 times respectively based on the 1 score of the model itself. Conclusion This model has the capacity for enhancing the accuracy of diagnosis the prostate cancer in the early stage, which could reduce the incidence of misdiagnosis and over diagnosis at same time. Key words: Prostate cancer; Early diagnosis; Magnetic resonance (MRI); Diagnostic model

Comparison of monopolar and bipolar diffusion weighted imaging sequences for detection of small hepatic metastases

ObjectiveTo compare monopolar (MP) and bipolar (BP) diffusion weighted imaging (DWI) in detecting small liver metastases. Materials and methodsEighty-eight patients underwent 3-T MRI. The signal-to-noise ratios (SNR) of the liver parenchyma and lesions, the lesion-to-liver contrast-to-noise ratios (CNR), and the detection sensitivities were compared. The lesion distortion was scored (LDS) from 4 (no distortion) to 1 (excessive distortion), dichotomised as no-distortion and distortion, and the association between detected lesions for each reader in the MP or BP DWI group and the dichotomised lesion distortion degree was assessed. ResultForty-six hepatic metastases were confirmed. The CNR with BP images showed significantly higher values than with MP (P=0.017). The detection sensitivities of the three readers were higher in the BP sequence than in MP, and one reader detected significantly more hepatic lesions with BP images (P=0.04). LDS was significantly improved with BP sequence (P=0.002). In the no-distortion group, excluding the MP DWI assessments of one reader, detection sensitivities were significantly higher than in the distortion group (P<0.001 and P=0.002, respectively). ConclusionReduced lesion distortion improves the detection of small liver metastases, and BP is more sensitive in detecting small liver metastases than MP DWI.

Antidepressant effects of magnetic resonance imaging—based stimulation on major depressive disorder: a double-blind randomized clinical trial

Antidepressant effects of magnetic resonance imaging (MRI) based stimulation have been reported in animal studies, but no human studies are available on subjects with major depressive disorder. Here, the efficacy of two diagnostic MRI protocols (echo-planar diffusion-weighted imaging (DWI) and T1-weighted imaging) was assessed in patients with major depressive disorder. In this double-blind randomized clinical trial, 51 patients with clinically proven major depressive disorder were randomly enrolled into three equal groups. All patients were receiving a selective serotonin reuptake inhibitor as the only antidepressant treatment. The first group received echo-planar DW stimulation (DWI group), the second group received T1-weighted stimulation (T1 group), and the third group experienced a similar condition without receiving any magnetic stimulation (sham group). The Hamilton rating scale for depression (HAMD24) and Beck depression inventory (BDI) were used to assess the effect of MR stimulation on depressive symptoms. In comparison to baseline, mean HAMD24 and BDI scores significantly (p < 0.001) decreased in the DWI (by 35% and 39%) and T1 (by 38% and 39%) groups 2weeks after MR stimulation. In the sham group, reduction in HAMD24 (19%, p = 0.04) and BDI score (15%, p = 0.07) were lower than the MR stimulation groups. Two weeks after the MR experiments, changes in mean HAMD24 score and BDI score were significantly (p < 0.05) higher in subjects treated with MR stimulation (DWI or T1) vs. sham group. In conclusion, this study demonstrated the antidepressant effects of DWI and T1 MRI protocols. Our results may point to usefulness of MR stimulation for clinical use in patients with major depressive disorder.

Lesion Patterns of Small Deep Infarcts Have Different Clinical and Imaging Characteristics

Background: The mechanisms underlying small deep infarcts in the subcortical area are unknown. This study used coronal diffusion-weighted imaging (DWI) to investigate clinical and radiological findings in patients with small deep infarcts. Methods: This was a retrospective study of consecutively admitted patients with small deep infarcts in the subcortical area. We divided the patients into two groups as follows: (1) those with isolated lesion (IL) defined as an IL in the parenchyma by coronal DWI (group A), and (2) those with linear lesion (LL), defined as a LL extending to the basal surface on coronal DWI (group B). Results: A total of 86 patients were included in this study, with 43 patients in each group. Neurological decline and ipsilateral MCA stenosis were observed more frequently in group B than in group A. Fluid-attenuated inversion recovery (FLAIR) signals showed that white-matter hyperintensity was more severe in group A than in group B (p = 0.015). Conclusions: This study suggests that LL patterns of small deep infarcts may result in a higher rate of neurological decline and ipsilateral MCA stenosis than IL patterns.

Periictal diffusion abnormalities of the thalamus in partial status epilepticus

To identify and describe thalamic dysfunction in patients with temporal as well as extratemporal status epilepticus (SE) and to also analyze the specific clinical, radiological, and electroencephalography (EEG) characteristics of patients with acute thalamic involvement. We retrospectively identified patients who presented with clinical and electrographic evidence of partial SE and had thalamic abnormalities on diffusion-weighted imaging (DWI) within 5 days of documentation of lateralized epileptiform discharges (group 1). The spatial and temporal characteristics of the periodic lateralized epileptiform discharges (PLEDs) and the recorded electrographic seizures were analyzed and correlated with magnetic resonance imaging (MRI)-DWI hyperintense lesions. The findings of group 1 patients were compared with those of patients with partial SE without thalamic abnormalities on DWI (group 2). The two groups were similar with regard to clinical presentation and morphology of epileptiform discharges. Group 1 patients had thalamic hyperintense lesions on DWI that appeared in the region of the pulvinar nucleus, ipsilateral to the epileptiform activity. Statistically significant relationship was noted between the presence of thalamic lesions and ipsilateral cortical laminar involvement (p = 0.039) as well as seizure origin in the posterior quadrants (p = 0.038). A trend towards PLEDs originating in the posterior quadrants was also noted (p = 0.077). Thalamic DWI hyperintense lesions may be observed after prolonged partial SE and are likely the result of excessive activity in thalamic nuclei having reciprocal connections with the involved cortex. The thalamus likely participates in the evolution and propagation of partial seizures in SE.