Validity of Negative High-Resolution Diffusion-Weighted Imaging in Transient Acute Cerebrovascular Events

A significant amount of strokes are reported to be diffusion-weighted imaging (DWI) negative in acute imaging. We attempted to quantify the rate of false-negative high-resolution (hr) DWI and to identify a valid screening tool to guide follow-up MRI to diagnose infarction initially not visible on hr...

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Bibliographic Details
Published in:Stroke (1970) 2013-09, Vol.44 (9), p.2598-2600
Main Authors: HOTTER, Benjamin, KUFNER, Anna, MALZAHN, Uwe, HOHENHAUS, Marc, JUNGEHÜLSING, Gerhard J, FIEBACH, Jochen B
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Cerebral Infarction - diagnosis
Diffusion Magnetic Resonance Imaging - instrumentation
Diffusion Magnetic Resonance Imaging - methods
Diffusion Magnetic Resonance Imaging - standards
Female
Humans
Ischemic Attack, Transient - diagnosis
Male
Medical sciences
Middle Aged
Neurology
Pharmacology. Drug treatments
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Severity of Illness Index
Time Factors
Vascular diseases and vascular malformations of the nervous system
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Summary:A significant amount of strokes are reported to be diffusion-weighted imaging (DWI) negative in acute imaging. We attempted to quantify the rate of false-negative high-resolution (hr) DWI and to identify a valid screening tool to guide follow-up MRI to diagnose infarction initially not visible on hrDWI. An a priori-defined post hoc analysis of a prospective 3T MRI cohort of acute cerebrovascular events imaged within 24 hours of ictus. Basic demographics, risk factors, National Institute of Health Stroke Scale, and imaging parameters were recorded. Of 151 patients with negative acute hrDWI, 63 received follow-up scans depicting infarction in 7 cases (11.1%). Persistence of clinical symptoms as established by National Institute of Health Stroke Scale on the following day was strongly associated with infarction on follow-up MRI (odds ratios, 17.5; 95% confidence interval, 2.83-108.12). Negative predictive value of follow-up National Institute of Health Stroke Scale was 0.96. Infarcts are frequently invisible on initial hrDWI, but we may well trust in negative hrDWI in completely transient cerebrovascular events.
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.113.001594