Diffusion-weighted MRI in acute subcortical infarction.
OBJECTIVE
Conventional imaging lacks sensitivity and specificity for the detection of early subcortical cerebral infarction. The purposes of our study were (1) to determine the accuracy of diffusion-weighted (DW) MRI for early subcortical infarction and (2) to determine the efficacy of DW MRI for differentiating acute from nonacute subcortical infarctions when conventional MR demonstrates multiple infarctions.


METHODS
Thirty-nine patients with clinically diagnosed acute subcortical infarction and 17 control subjects were imaged with both conventional and DW MRI from 7 hours to 4 days (mean, 2.0 days) after onset of symptoms. All images were read blinded to specific clinical findings. In all cases, the precise neuroanatomic locations of lesions were noted. These lesions were subsequently correlated by an experienced stroke neurologist to determine whether their locations correlated to the patients' symptoms.


RESULTS
The accuracy of DW MRI for acute subcortical infarction was 94.6%. In 4 of 39 cases, the acute infarction was not detected on conventional MRI. In 24 of 39 cases, conventional MRI showed the acute lesion as well as multiple other subcortical lesions. In each of these 24 cases, the DW MRI showed a single lesion to be acute, and in all 24 cases, that lesion corresponded to the patients' acute symptoms.


CONCLUSIONS
DW MRI has very high accuracy for acute subcortical infarction and can differentiate acute from nonacute lesions. These data have significant implications in guiding patient management and patient selection for clinical trials.
Singer
M B
MB
Department of Radiology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Chong
J
J
Lu
D
D
Schonewille
W J
WJ
Tuhrim
S
S
Atlas
S W
SW
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000098:blood supply; D002545:Brain Ischemia / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D001933:Brain Stem / Q000098:blood supply; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D002986:Clinical Trials as Topic; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D018579:Patient Selection; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013997:Time Factors