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Baggett M, Helmy D, Chang J, Bobinski M, Assadsangabi R. Added value in stroke imaging: accuracy and utility of additional coronal diffusion-weighted imaging. Clin Radiol 2021; 76:785.e1-785.e7. [PMID: 34384563 DOI: 10.1016/j.crad.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the value of adding additional coronal diffusion-weighted imaging with the same section thickness as standard axial images to improve detection of small infarcts. MATERIALS AND METHODS Axial and coronal diffusion-weighted images (4 or 5 mm section thickness, 1 mm gap) were studied retrospectively in two rounds of data collection. During the first round, two radiologists identified sub-centimetre infarcts on only axial images during one sitting, and only coronal images during a second sitting. During the second round, the two radiologists were asked to identify infarcts on only axial images during one sitting, and on both axial and coronal images simultaneously during the second sitting. An expert reviewer determined true infarcts and artefacts. Relative contrast-to-noise ratios (rCNR) and relative mean region of interest (rROI) within each lesion were calculated. RESULTS During the first round, sensitivity for infarct detection for the two radiologists was 92.7% and 100% on axial and 95.1% and 92.7% on coronal, respectively. During the second round, sensitivity improved from 88.9% to 98.1% for both radiologists (p=0.03). Specificity improved but did not reach statistical significance (p=0.06 and 0.12). False-negative and false-positive lesions had lower rCNR and rROI values. CONCLUSION Including both axial and coronal DWI images with the same section thickness in the stroke protocol improves detection of small infarcts, which can be misdiagnosed on a single imaging plane. A second imaging plane is particularly useful for subtle infarcts, even without acquiring thin-section images.
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Affiliation(s)
- M Baggett
- Department of Radiology, University of California, Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.
| | - D Helmy
- Department of Radiology, University of California, Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - J Chang
- Department of Radiology, University of California, Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - M Bobinski
- Department of Radiology, University of California, Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - R Assadsangabi
- Department of Radiology, University of California, Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
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Steffen P, Beyer LS, McDonough R, Thaler C, Faizy T, Fiehler J, Gbadamosi J, Habermann CR, Schönfeld MH. Improved Detectability of Brain Stem Ischemia by Combining Axial and Coronal Diffusion-Weighted Imaging. Stroke 2021; 52:1843-1846. [PMID: 33813862 DOI: 10.1161/strokeaha.120.032457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the benefit of a coronal diffusion-weighted imaging (DWI) in addition to standard axial DWI for the detection of brain stem infarctions. METHODS A retrospective analysis of patients with symptoms consistent with acute and subacute brain stem infarction who received magnetic resonance imaging, including axial and coronal DWI. Diffusion restrictions were identified by 2 independent raters blinded for the final clinical diagnosis in 3 separate reading steps: axial DWI, coronal DWI, and combined axial and coronal DWI. Lesion location and certainty level were both documented for each reading step. In cases of reader disagreement, an additional consensus reading was performed. RESULTS Two hundred thirty-nine patients were included. Of these, 124 patients (51.9%) were clinically diagnosed with brain stem infarction. Sensitivity, specificity, positive, and negative predictive values were best for combined DWI assessment (90.3%, 99.1%, 99.1%, and 90.5%) compared with axial (85.5%, 94.9%, 94.6%, and 85.8%) and coronal DWI alone (87.9%, 96.5%, 96.5%, and 88.1%). Diffusion restriction on combined DWI was diagnosed in 112/124 patients compared with 106/124 on axial DWI and 109/124 on coronal DWI. Interobserver agreement for the detection of brain stem lesions was the highest in the combined rating step (Cohen κ coefficient=0.94). CONCLUSIONS Coronal DWI sequences might improve the detection rate of brain stem infarction compared with standard axial DWI. The combined coronal and axial DWI provides the best detection rate while minimally increasing scan times.
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Affiliation(s)
- Paul Steffen
- Department of Diagnostic and Interventional Radiology (P.S., L.-S.B., C.T., T.F., C.R.H.), Marienkrankenhaus Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.S., R.M., C.T., T.F., J.F., M.H.S.)
| | - Lara-Sophie Beyer
- Department of Diagnostic and Interventional Radiology (P.S., L.-S.B., C.T., T.F., C.R.H.), Marienkrankenhaus Hamburg, Germany
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.S., R.M., C.T., T.F., J.F., M.H.S.)
| | - Christian Thaler
- Department of Diagnostic and Interventional Radiology (P.S., L.-S.B., C.T., T.F., C.R.H.), Marienkrankenhaus Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.S., R.M., C.T., T.F., J.F., M.H.S.)
| | - Tobias Faizy
- Department of Diagnostic and Interventional Radiology (P.S., L.-S.B., C.T., T.F., C.R.H.), Marienkrankenhaus Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.S., R.M., C.T., T.F., J.F., M.H.S.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.S., R.M., C.T., T.F., J.F., M.H.S.)
| | | | - Christian R Habermann
- Department of Diagnostic and Interventional Radiology (P.S., L.-S.B., C.T., T.F., C.R.H.), Marienkrankenhaus Hamburg, Germany
| | - Michael H Schönfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.S., R.M., C.T., T.F., J.F., M.H.S.).,Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany (M.H.S.)
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Takeshige N, Aoki T, Sakata K, Kajiwara S, Negoto T, Nagase S, Tanoue S, Uchiyama Y, Hirohata M, Abe T, Morioka M. Sagittal diffusion-weighted imaging in preventing the false-negative diagnosis of acute brainstem infarction: Confirmation of the benefit by anatomical characterization of false-negative lesions. Surg Neurol Int 2019; 10:180. [PMID: 31637081 PMCID: PMC6778332 DOI: 10.25259/sni_182_2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/08/2019] [Indexed: 11/06/2022] Open
Abstract
Background: In some cases of acute brainstem infarction (BI), standard axial diffusion-weighted imaging (DWI) does not show a lesion, leading to false-negative (FN) diagnoses. It is important to recognize acute BI accurately and promptly to initiate therapy as soon as possible. Methods: Of the 171 patients with acute cerebral infarctions in our institution who were examined, 16 were diagnosed with true-positive BI (TP-BI) and six with FN-BI. We evaluated the effectiveness of sagittal DWI in accurately diagnosing acute BI and sought to find the cause of its effectiveness by the anatomical characterization of FN-BIs. Results: Considering the direction of the brainstem perforating arteries, we supposed that sagittal DWI might more effectively detect BIs than axial DWI. We found that sagittal DWI detected all FN-BIs more clearly than axial DWI. The mean time between the onset of symptoms and initial DWI was significantly longer in the TP group (17.6 ± 5.5 h) than in the FN group (5.0 ± 1.2 h; P < 0.0001). The lesion volumes were much smaller in FN-BIs (259 ± 82 mm3) than in TP-BIs (2779 ± 767 mm3; P = 0.0007). FN-BIs had a significant inverse correlation with the ventrodorsal length of infarcts (FN 3.5 ± 1.1 mm, TP 11.4 ± 3.6 mm; P < 0.0004) and no correlation with other size parameters such as rostrocaudal thickness and lateral width. Conclusion: Anatomical characterization clearly confirmed that the addition of sagittal DWI to the initial axial DWI in suspected cases of BI ensures its accurate diagnosis and improves the patient’s prognosis.
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Affiliation(s)
- Nobuyuki Takeshige
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takachika Aoki
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiyohiko Sakata
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Soushou Kajiwara
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tetsuya Negoto
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Satoshi Nagase
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Syuichi Tanoue
- Departments of Radiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yusuke Uchiyama
- Departments of Radiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masaru Hirohata
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Toshi Abe
- Departments of Radiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Motohiro Morioka
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Khaleel NI, Zghair MAG, Hassan QA. Value of Combination of Standard Axial and Thin-Section Coronal Diffusion-weighted Imaging in Diagnosis of Acute Brainstem Infarction. Open Access Maced J Med Sci 2019; 7:2287-2291. [PMID: 31592276 PMCID: PMC6765079 DOI: 10.3889/oamjms.2019.336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
AIM: To determine the value of the combination of thin-section 3 mm coronal and standard axial DWI and their impact in facilitating the diagnosis of acute brainstem infarction. METHODS: A cross-sectional study conducted from the 1st of April 2017 to the end of February 2018 on 100 consecutive patients (66% were male, and 34% were female) with isolated acute ischemic infarction in the brainstem. The abnormal MRI findings concerning the ischemic lesions were interpreted on standard axial 5 mm and thin-section coronal 3mm DWI. RESULTS: The mean age of the studied group was 69.2 ± 4.3 for male and 72.3 ± 2.5 years. The standard axial DWI can diagnose 20%, 6.7% and 6.7% of the infarctions in midbrain, pons and medulla oblongata respectively, while both axial and thin coronal sections together can diagnose 80% of midbrain infarctions, 93.3% of pons infarctions and 93.3% of medulla oblongata infarctions. Furthermore, the thin section coronal 3 mm section can diagnose very smaller ischemic lesion volume in comparison to the standard axial 5mm section (3.4 ± 0.45 / cm3 versus 4.6 ± 0.23 / cm3, P < 0.001) CONCLUSION: The addition of thin-section coronal DWI can facilitate the detection of brainstem ischemic lesions. We suggest its inclusion in the stroke MRI protocol.
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Affiliation(s)
- Nashwan I Khaleel
- Department of Radiology, Al-Yarmook Teaching Hospital, Baghdad, Iraq
| | - Muna A G Zghair
- Division of Radiology, Department of Medicine, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
| | - Qays A Hassan
- Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
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Schönfeld MH, Ritzel RM, Kemmling A, Ernst M, Fiehler J, Gellißen S. Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI. PLoS One 2018; 13:e0200092. [PMID: 29969485 PMCID: PMC6029789 DOI: 10.1371/journal.pone.0200092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/19/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Most false negative findings in DWI of ischemic stroke are in patients with minor deficits clinically localized to the brainstem. Our goal was to evaluate the benefit of a thin-sliced sagittal DWI in addition to conventional axial DWI at 1.5T for the detection of brainstem infarctions. METHODS Data of patients with symptoms consistent with acute and subacute brainstem infarction and an MRI examination including standard axial DWI and thin-sliced sagittal DWI were retrospectively analyzed. Patients with the later diagnosis of a TIA, an inflammation or a tumor of the brainstem were excluded from analysis. Diffusion restrictions were identified by two independent raters blinded for the final clinical diagnosis in three separate reading steps: First, only axial DWI, secondly only sagittal DWI, and lastly both DWIs together. Presence and size of DWI-lesions were documented for each plane. Differences between the observers were settled in consensus in a separate joint reading. RESULTS Of 73 included patients, 46 patients were clinically diagnosed with brainstem infarction. Inter-observer agreement was excellent for the detection of brainstem lesions in axial and sagittal DWI (kappa = 0.94 and 0.97). In 28/46 patients (60.9%) lesions were detected in the axial plane alone, whereas in 6 more patients (73.9%) lesions were detected in the review of both sequences together. All lesions undetectable in the axial plane were smaller than 5 mm in cranio-caudal direction. CONCLUSIONS Thin-sliced sagittal DWI in addition to axial DWI improves the detection rate of brainstem infarction with little additional expenditure of time.
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Affiliation(s)
- Michael H. Schönfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Robert M. Ritzel
- Department of Radiology, German Armed Forces Hospital Hamburg, Hamburg, Germany
| | - Andre Kemmling
- Department of Neuroradiology, University Hospital of Luebeck, Luebeck, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Felfeli P, Wenz H, Al-Zghloul M, Groden C, Förster A. Combination of standard axial and thin-section coronal diffusion-weighted imaging facilitates the diagnosis of brainstem infarction. Brain Behav 2017; 7:e00666. [PMID: 28413710 PMCID: PMC5390842 DOI: 10.1002/brb3.666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/25/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Although diffusion-weighted imaging (DWI) is a very sensitive technique for the detection of small ischemic lesions in the human brain, in particular in the brainstem it may fail to demonstrate acute ischemic infarction. In this study, we sought to evaluate the value of additional thin-section coronal DWI for the detection of brainstem infarction. METHODS In 155 consecutive patients (median age 69 [interquartile range, IQR 57-78] years, 95 [61.3%] males) with isolated brainstem infarction, MRI findings were analyzed, with emphasis on ischemic lesions on standard axial (5 mm) and thin-section coronal (3 mm) DWI. RESULTS On DWI, we identified ischemic lesions in the mesencephalon in 12 (7.7%), pons in 115 (74.2%), and medulla oblongata in 31 (20%) patients. In 3 (1.9%) cases-all of these with medulla oblongata infarction-the ischemic lesion was detected only on thin-section coronal DWI. Overall, in 35 (22.6%) patients the ischemic lesion was more easily identified on thin-section coronal DWI in comparison to standard axial DWI. In these, the ischemic lesions were significantly smaller (0.06 [IQR 0.05-0.11] cm3 vs. 0.25 [IQR 0.13-0.47] cm3; p < .001) in comparison to those patients whose ischemic lesion was more easily (6 [3.9%]) or at least similarly well identified (114 [73.5%]) on standard axial DWI. CONCLUSIONS Since thin-section coronal DWI may facilitate the diagnosis of brainstem infarction, we suggest its inclusion in standard stroke MRI protocols.
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Affiliation(s)
- Philippe Felfeli
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Holger Wenz
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Mansour Al-Zghloul
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Christoph Groden
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Alex Förster
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
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Entwisle T, Perchyonok Y, Fitt G. Thin section magnetic resonance diffusion-weighted imaging in the detection of acute infratentorial stroke. J Med Imaging Radiat Oncol 2016; 60:616-623. [DOI: 10.1111/1754-9485.12490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 05/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Tom Entwisle
- Radiology Department; Austin Health; Heidelberg Victoria Australia
| | | | - Greg Fitt
- Radiology Department; Austin Health; Heidelberg Victoria Australia
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8
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Prakkamakul S, Schaefer P, Gonzalez G, Rapalino O. MRI Patterns of Isolated Lesions in the Medulla Oblongata. J Neuroimaging 2016; 27:135-143. [DOI: 10.1111/jon.12361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/13/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Supada Prakkamakul
- Neuroradiology Division, Department of Radiology; Massachusetts General Hospital; 55 Fruit Street Boston MA
- Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Faculty of Medicine; Chulalongkorn University; 1873 Rama IV Road Pathumwan Bangkok Thailand
| | - Pamela Schaefer
- Neuroradiology Division, Department of Radiology; Massachusetts General Hospital; 55 Fruit Street Boston MA
| | - Gilberto Gonzalez
- Neuroradiology Division, Department of Radiology; Massachusetts General Hospital; 55 Fruit Street Boston MA
| | - Otto Rapalino
- Neuroradiology Division, Department of Radiology; Massachusetts General Hospital; 55 Fruit Street Boston MA
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9
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Discrimination of Acute Ischemic Stroke from Nonischemic Vertigo in Patients Presenting with Only Imbalance. J Stroke Cerebrovasc Dis 2014; 23:888-95. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/17/2013] [Accepted: 07/21/2013] [Indexed: 11/19/2022] Open
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de Mendivil AO, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM. Brainstem Stroke: Anatomy, Clinical and Radiological Findings. Semin Ultrasound CT MR 2013; 34:131-41. [DOI: 10.1053/j.sult.2013.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brunser AM, Illanes S, Lavados PM, Muñoz P, Cárcamo D, Hoppe A, Olavarria VV, Delgado I, Díaz V. Exclusion criteria for intravenous thrombolysis in stroke mimics: an observational study. J Stroke Cerebrovasc Dis 2012; 22:1140-5. [PMID: 23253534 DOI: 10.1016/j.jstrokecerebrovasdis.2012.10.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/04/2012] [Accepted: 10/31/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Stroke mimics (SMs) are frequent in emergency departments (EDs), but are treated infrequently with intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis. We aimed at identifying the factors that lead to the exclusion of SMs from thrombolytic therapy. METHODS Consecutive patients presenting to the ED between December 2004 and March 2011 with symptoms that suggested acute ischemic stroke were included. RESULTS Eight hundred forty-two patients were included in this study; 113 (13.4%) were considered SMs; these patients were younger (P = .01), more frequently diabetic (P = .001), arrived later to the ED (P = .03), had lower National Institutes of Health Stroke Scale scores (P < .001), and higher frequencies of negative diffusion-weighted imaging studies (P = .002). The most common causes of cases of SM were toxic metabolic disorders (n = 34 [30.1%]) and seizures (n = 22 [19.5%]). The most frequent cause of consultation was aphasia (n = 43 [37.6%]). SM patients had a total of 152 contraindications for rt-PA, with 34 (30%) patients having >1 contraindication. The most frequent of these were being beyond the therapeutic window for thrombolysis (n = 96) and having deficits not measurable by the National Institutes of Health Stroke Scale or very mild symptoms before the start of rt-PA (n = 37). Twenty-four (21.2%) patients had both contraindications simultaneously. Two patients (1.76%) in the SM group were candidates for rt-PA but did not receive this treatment because they or their family rejected it. Of 729 stroke patients, 87 (11.9%) did receive rt-PA. CONCLUSIONS SM patients frequently had exclusion criteria for systemic thrombolysis, the most frequent being presenting beyond the established thrombolytic window.
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Affiliation(s)
- Alejandro M Brunser
- Cerebrovascular Program, Neurology Service, Department of Internal Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
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Morita N, Harada M, Satomi J, Terasawa Y, Kaji R, Nagahiro S. Frequency of emerging positive diffusion-weighted imaging in early repeat examinations at least 24 h after transient ischemic attacks. Neuroradiology 2012; 55:399-403. [DOI: 10.1007/s00234-012-1113-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
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13
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Nakatani Y, Takahira M, Sugiyama K. Brainstem Infarction in Pupil-Sparing Oculomotor Nerve Palsy Detected by Diffusion-Weighted Magnetic Resonance Imaging. Neuroophthalmology 2012. [DOI: 10.3109/01658107.2011.647375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fung SH, Roccatagliata L, Gonzalez RG, Schaefer PW. MR Diffusion Imaging in Ischemic Stroke. Neuroimaging Clin N Am 2011; 21:345-77, xi. [DOI: 10.1016/j.nic.2011.03.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Guzmán-De-Villoria JA, Fernández-García P, Ferreiro-Argüelles C. Differential diagnosis of T2 hyperintense brainstem lesions: Part 1. Focal lesions. Semin Ultrasound CT MR 2010; 31:246-59. [PMID: 20483392 DOI: 10.1053/j.sult.2010.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brainstem lesions can be classified as focal or diffuse. Magnetic resonance imaging is the most suitable imaging modality for evaluating these lesions. As a rule, focal lesions are not large and have well-defined margins. Causes include tumors, vascular malformations, demyelinating diseases, brain abscesses, hypertrophic olivary degeneration, and dilated Virchow-Robin spaces. Differential diagnoses of these numerous entities mandates a review of magnetic resonance imaging findings in conjunction with epidemiologic aspects, clinical features, and other medical test results.
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Affiliation(s)
- Juan A Guzmán-De-Villoria
- Department of Radiology/Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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16
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Matsuoka A, Minato M, Harada M, Kubo H, Bandou Y, Tangoku A, Nakano K, Nishitani H. Comparison of 3.0-and 1.5-tesla diffusion-weighted imaging in the visibility of breast cancer. ACTA ACUST UNITED AC 2008; 26:15-20. [PMID: 18236129 DOI: 10.1007/s11604-007-0187-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 08/23/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare diffusion-weighted imaging (DWI) at 3.0 T and 1.5 T by evaluating the apparent diffusion coefficient (ADC) value and visibility of breast cancer in the same patients. MATERIALS AND METHODS A total of 13 patients (16 lesions) with breast cancer underwent DWI at 3.0 T and 1.5 T. Tumors were classified into two groups based on the lesion size. The ADC values were measured, and visibility of the tumors was scored blindly. RESULTS No significant difference was found for ADC values between 3.0 T and 1.5 T in either group (P > 0.05). All of the large lesions were visible clearly at both magnetic field strengths, and image scores were not different (P > 0.05). In contrast, small lesions were more clearly visible and had better image scores at 3.0 T than at 1.5 T (P < 0.001). CONCLUSION Small cancers were more clearly visible on DWI at 3.0 T than 1.5 T.
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Affiliation(s)
- Aoi Matsuoka
- Nishitani Department of Radiology, School of Medicine, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima 770-8509, Japan.
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SORIMACHI T, ITO Y, MORITA K, FUJII Y. Thin-Section Diffusion-Weighted Imaging of the Infratentorium in Patients With Acute Cerebral Ischemia Without Apparent Lesion on Conventional Diffusion-Weighted Imaging. Neurol Med Chir (Tokyo) 2008; 48:108-13. [DOI: 10.2176/nmc.48.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yasushi ITO
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | | | - Yukihiko FUJII
- Department of Neurosurgery, Brain Research Institute, Niigata University
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Inatomi Y, Yonehara T, Hashimoto Y, Hirano T, Uchino M. Occlusive vessel signs on MRI as only findings of hyperacute ischemic stroke. J Neurol Sci 2007; 268:187-9. [PMID: 18061207 DOI: 10.1016/j.jns.2007.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 10/16/2007] [Accepted: 10/29/2007] [Indexed: 11/25/2022]
Abstract
A 64-year-old woman presented with a partial seizure on the left side of her face. Although diffusion weighted images and magnetic resonance angiography 3 h after the onset did not show any signs of ischemic stroke, a susceptibility vessel sign (SVS) on T2*-weighted gradient echo imaging (GRE) and a hyperintense vessel sign (HVS) on fluid attenuated inversion recovery images at the distal branch of the right middle cerebral artery were revealed. One day later, these GRE SVS and HVS signs disappeared and a new infarct lesion in the right insular cortex was found on magnetic resonance images (MRI). It is suggested that occlusive vessel signs on MRI, including GRE SVS and HVS, are sometimes the only findings of ischemic stroke at the hyperacute phase.
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Affiliation(s)
- Yuichiro Inatomi
- Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Japan.
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Schulte-Altedorneburg G, Brückmann H. [Imaging techniques in diagnosis of brainstem infarction]. DER NERVENARZT 2006; 77:731-43; quiz 744. [PMID: 16736174 DOI: 10.1007/s00115-006-2091-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Twenty per cent of cerebral ischaemic infarctions involve tissue, supplied by the vertebrobasilar circulation. This overview of the current literature and our own experiences present the value of different imaging techniques (CT and MRI) and new developments for diagnosing brainstem infarction. Furthermore, the roles of invasive and noninvasive vascular imaging methods (computed tomographic angiography, magnetic resonance angiography, intra-arterial angiography, ultrasound) for evaluating vertebrobasilar stenosis and occlusion are described. The diagnostic workup of the most severe form of brainstem infarction, basilar artery thrombosis, is shown.
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Affiliation(s)
- G Schulte-Altedorneburg
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
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Meek MF, Stenekes MW, Hoogduin HM, Nicolai JPA. In vivo three-dimensional reconstruction of human median nerves by diffusion tensor imaging. Exp Neurol 2006; 198:479-82. [PMID: 16455078 DOI: 10.1016/j.expneurol.2005.12.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Accepted: 12/15/2005] [Indexed: 11/30/2022]
Abstract
The in vivo assessment of axonal projections of the peripheral nervous system has been severely limited by the lack of noninvasive techniques. We examined whether MR diffusion tensor imaging with fiber tracking of the human median nerve is feasible. The median nerve was examined with a 3-T MRI scanner in wrists of three healthy volunteers and the wrist of a patient after median nerve repair. In vivo three-dimensional (3D) reconstruction of axonal projections of the median nerve could be achieved in healthy volunteers with intact median nerves and a patient with a transected median nerve using diffusion tensor imaging combined with fiber tracking. The median nerve could be visualized and correlated well to the expected location on T1-weighted images in the patient and all volunteers. The transected median nerve in the patient could be detected up to the site of repair one month postoperatively, whereas the nerve could not be detected more distally immediately after repair. Two months postoperatively, it could clearly be tracked more distally, indicating nerve regeneration. Diffusion tensor imaging can detect the median nerve in healthy individuals as well as up to the lesion site in a patient with a complete transection of the median nerve.
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Affiliation(s)
- Marcel F Meek
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30000, 9700 RB Groningen, The Netherlands.
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Blitshteyn S, Hentschel K, Czervionke LF, Eidelman BH. Transient vertical diplopia and nystagmus associated with acute thalamic infarction. Clin Imaging 2006; 30:54-6. [PMID: 16377486 DOI: 10.1016/j.clinimag.2005.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 07/10/2005] [Indexed: 11/22/2022]
Abstract
We describe a patient who presented with a 1-h history of vertical diplopia and nystagmus and was found to have acute left ventrolateral thalamic infarction on the diffusion-weighted magnetic resonance imaging (DWI MRI). This is the first case report demonstrating that vertical diplopia and nystagmus, which typically suggest a lesion in the brainstem or cerebellum, may also occur in acute thalamic infarction. DWI MRI can detect thalamic infarction as early as 1 h after its clinical manifestations.
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Affiliation(s)
- Svetlana Blitshteyn
- Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA.
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Blitshteyn S, Rubino FA. Pure Sensory Stroke as an Isolated Manifestation of the Lateral Medullary Infarction. J Neuroimaging 2005. [DOI: 10.1111/j.1552-6569.2005.tb00291.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Etgen T, Gräfin von Einsiedel H, Röttinger M, Winbeck K, Conrad B, Sander D. Detection of Acute Brainstem Infarction by Using DWI/MRI. Eur Neurol 2004; 52:145-50. [PMID: 15492483 DOI: 10.1159/000081623] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Accepted: 07/27/2004] [Indexed: 11/19/2022]
Abstract
Even using diffusion-weighted images (DWI) detection of acute brainstem infarction (BI) is still a challenge. To evaluate the clinical efficacy of a DWI protocol with improved spatial resolution all images of 44 patients with clinically possible BI on admission (24 patients with definite BI and 20 patients with other etiologies) and first DWI within 24 h after symptom onset were blindly reanalyzed for visibility and detection of BI on the first DWI by reviewers with different expertise levels. Neuroradiologists identified definite BI in 21 out of 24 patients (sensitivity 90%, specificity 100%); neurologists and junior house officers achieved similar results (sensitivity 86 and 83%, specificity 98 and 97%). The use of DWI allows a definite diagnosis of BI, even if raters have limited experience.
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Affiliation(s)
- Thorleif Etgen
- Department of Neurology, Technical University of Munich, Munich, Germany.
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