Combination of standard axial and thin‐section coronal diffusion‐weighted imaging facilitates the diagnosis of brainstem infarction

Felfeli, Philippe; Wenz, Holger; Al-Zghloul, Mansour; Groden, Christoph; Förster, Alex

doi:10.1002/brb3.666

Cited by 21 publications

(18 citation statements)

References 9 publications

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“…While the use of an additional plane and thinner slices for brainstem infarctions is common and recommended even in textbooks[ 15 , 16 ], evidence to back up the recommendations for thin sliced axial DWI is rare[ 13 ] and the benefit of an additional DWI acquired in the sagittal plane has only been anecdotal[ 17 ]. Recently it was shown that the combination of standard axial and thin-sectional coronal DWI facilitates the diagnosis of brainstem infarction but the effect was much smaller than in our study with only 3 out of 155 brainstem infarcts only detectable on the coronal DWI[ 14 ]. To the best of our knowledge this is the first study evaluating the recommendation for the acquisition in an additional sagittal plane systematically.…”

Section: Discussioncontrasting

confidence: 69%

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Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI

Schönfeld

Ritzel²,

Kemmling

et al. 2018

PLoS ONE

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Background and purposeMost 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.MethodsData 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.ResultsOf 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.ConclusionsThin-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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Section: Discussioncontrasting

confidence: 69%

“…To overcome this issue, acquisition of additional thin-sliced DWI sequences is recommended in some textbooks, but the usefulness of these recommendations has only been shown for an additional thin-sliced axial and coronal DWI[ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI

Schönfeld

Ritzel²,

Kemmling

et al. 2018

PLoS ONE

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“…The current study results showed that combined coronal and axial DWI could better demonstrate the ischemic lesion of the midbrain in 8 (80%), of the pons in 56 (93.3%) and the medulla oblongata in 28 (93.3%). These values were more than that found in Felfeli P et al, [16] study where the thin-section coronal DWI was better identified the ischemic lesions of the midbrain in 8.6%, of the pons in 45.7%, and the medulla oblongata in 45.7%.…”

Section: Discussionmentioning

confidence: 52%

“…In a study done by Felfeli P et al, [16] in 2017, only 2% of cases of acute brainstem infarction were detected by thin-section coronal DWI. Our study showed that (92.0%) of patients were easily seen by both sequence (standard axial and added thin coronal section) of DWI, and only (8%) can be easily seen by axial DWI section.…”

Section: Discussionmentioning

confidence: 99%

Value of Combination of Standard Axial and Thin-Section Coronal Diffusion-weighted Imaging in Diagnosis of Acute Brainstem Infarction

Khaleel¹,

Zghair²,

Hassan³

2019

Open Access Maced J Med Sci

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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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“…Although DWI is the current gold-standard for the detection of acute ischemic stroke [ 13 ], DWI sometimes fails to detect very small ischemic lesions, especially those in the posterior fossa. Recent studies have shown that the performance of additional thin-section, coronal DWI of the posterior fossa can overcome this problem.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Upper Cervical Cord Infarction: A Report of Two Cases with Mild Neurological Symptoms Accompanying a Small Ischemic Lesion Detected by Brain MRI

Wada

Nagasawa

Yamaguchi

2020

Case Reports in Neurological Medicine

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Spinal cord infarction (SCI) is rare, difficult to diagnose, and often fails to be detected by diffusion-weighted imaging (DWI) of spinal cord magnetic resonance imaging (MRI). Because the clinical features of SCI can vary widely, diagnosis during the acute phase of SCI is often challenging for clinicians. Although SCI shares similar etiologies with cerebral infarction, the characteristics of SCI without vessel dissection remain largely unknown. We present two older patients with mild neurological symptoms who each presented with a small, unilateral, upper cervical cord lesion, which was detected by thin-section, coronal DWI of brain MRI. Both unilateral small lesions were localized in the right lateral funiculus, and each patient showed good prognosis. The anatomical findings suggested that the pial collateral network surrounding the cervical cord contributed to lesion formation. Small and localized lesions have been associated with mild neurological symptoms and better short-term prognosis. The present report indicated that the use of thin-section coronal DWI when performing brain MRI may be helpful for the diagnosis of small, unilateral, upper cervical cord infarctions.

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Combination of standard axial and thin‐section coronal diffusion‐weighted imaging facilitates the diagnosis of brainstem infarction

Cited by 21 publications

References 9 publications

Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI

Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI

Value of Combination of Standard Axial and Thin-Section Coronal Diffusion-weighted Imaging in Diagnosis of Acute Brainstem Infarction

Unilateral Upper Cervical Cord Infarction: A Report of Two Cases with Mild Neurological Symptoms Accompanying a Small Ischemic Lesion Detected by Brain MRI

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