A retrospective analysis of negative diffusion-weighted image results in patients with acute cerebral infarction

Abstract

We aimed to investigate the clinicoradiologic determinants of negative diffusion-weighted image (DWI) results in patients with acute cerebral infarction (ACI). The medical records were reviewed of ACI patients. Patients were divided to the DWI positive and negative group. Positive DWI was used as independent variable and patients' clinicoradiologic factors were used as co-variables for multivariate logistic regression analysis. 349 patients received initial cerebral MRI within 72 hours of admission. Lacunar infarction was most common (42.1%) followed by posterior circulation infarction (30.1%) and partial anterior circulation infarction (18.1%). The majority of the patients (72.2%) had an NIHSS score of less than 5 at admission. 316 patients (90.54%) were positive on initial DWI. Patients with smoking, initial SBP ≥ 140 or DBP ≥ 90 mmHg, initial fasting plasma glucose (FPG) ≥7.0 mmol/L, initial MRI from onset of disease >1 d and anterior circulation infarction were liable to show positive DWI. Furthermore, DWI negative patients had significantly lower NIHSS scores (IQR 0,1,2) than DWI positive patients (IQR 1,2,4) (P = 0.000) at two weeks post onset of acute cerebral infarction. In conclusion, multiple clinicoradiologic factors are associated with negative and positive DWI and further delineation of these factors is required in future prospective studies.

Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

“…It is not uncommon for patients with acute vestibular symptoms due to stroke to be either initially misdiagnosed with peripheral vestibular disease or have a delay in definitive diagnosis (Calic, Cappelen‐Smith, Anderson, Xuan, & Cordato, 2016). Moreover, DWI is associated with false negative results when performed very early, especially for posterior circulation infarction (Zuo et al., 2015). For these reasons, identification of factors that may indicate which patients have isolated vertigo or dizziness caused by cerebral infarction is clinically important.…”

Advanced Pediatric Neurosonography Techniques: Contrast‐Enhanced Ultrasonography, Elastography, and Beyond

“…In future studies applying CEUS techniques with hypoxic ischemic injury, it is important that a direct comparison is made to the currently accepted gold‐standards. It is well recognized that depending on the timing and type of injury, varying patterns of signal or diffusion alterations are seen on diffusion‐weighted sequence, T2‐weighted sequence, and arterial spin labeling perfusion sequence . Assuming that the perfusion abnormalities can be reproducibly detected with the CEUS technique, they may not correlate exactly with either the diffusion‐weighted or perfusion sequences on MRI.…”

“…It is well recognized that depending on the timing and type of injury, varying patterns of signal or diffusion alterations are seen on diffusion-weighted sequence, T2-weighted sequence, and arterial spin labeling perfusion sequence. 37 Assuming that the perfusion abnormalities can be reproducibly detected with the CEUS technique, they may not correlate exactly with either the diffusion-weighted or perfusion sequences on MRI. Note that in neonates and infants, the resolution of perfusion-weighted MRI sequences is oftentimes suboptimal for accurate interpretation.…”

BMC NeurologyFactors determining recurrence in transient global amnesia

“…We were not able to assess the minimum MRI latency for positive lesions; however, infarctions on MRI within 24 hours may only have 82% sensitivity, creating a high frequency of false-negatives in this timeframe. [32][33][34] Posterior circulation infarctions are much likelier to give false-negative DWIs than an anterior circulation infarction. [34] Blood supply to the hippocampus is complicated as it is variable.…”