Diffusion weighted magnetic resonance imaging for acute stroke: practical and popular

Abstract

Aim: To evaluate the feasibility and impact of diffusion weighted magnetic resonance imaging (DW MRI) as the first line neuroimaging of stroke at a district general hospital. Methods: Prospective audit of all in-patients admitted with clinically suspected acute stroke and referred for imaging over a consecutive 17 week period. The data collected included scan type, time from cerebral event to imaging request, and time from formal radiological request to neuroimaging. Clinicians' (general physicians, neurologists, and radiologists) perceptions were assessed by a questionnaire. Results: 148 patients had neuroimaging for clinically suspected stroke during this period. Eighty one per cent of patients (120 of 148) had DW MRI as first line. Ninety two per cent of these patients had DW MRI within 24 hours of the formal radiological request. Twenty eight patients did not undergo DW MRI because lack of MRI safety, clinical state, unavailability because of maintenance service or lack of trained staff. Clinicians found the introduction of the DW MRI based service a significant improvement on computed tomography, especially for equivocal cases. Conclusion: DW based MRI service is both feasible and sustainable in the setting of a district general hospital and most clinicians feel that this is a significant improvement to stroke services.

Acute medical care

“…We agree CT imaging is adequate for assessing patients for thrombolysis, but MRI of stroke is superior to CT. 1 With the use of limited sequences, rapid imaging is possible with greater accuracy than CT in the district general hospital setting and can be performed in the majority of acute stroke patients. 2,3 MRI also allows a more accurate determination of the vascular distribution of the event and the pattern of infarction can also provide clues to the cause of the event. 4,5 Multimodal MRI does not appear to carry the risk of multimodal CT scanning.…”

MRI-Based Neuroanatomical Predictors of Dysphagia after Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…Recent advances in neuroimaging have made associating lesions with stroke severity possible [3,4,5]. Magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and T1- and T2-weighted scans, quantifies brain lesion sites and volumes, facilitating the diagnosis of stroke type, prior stroke and acute stroke.…”

“…A positive DWI scan distinguishes an acute infarct from an old infarct better than T2-weighted [8,9] or computed tomography (CT) scans [10,11]. DWI scans are frequently acquired in the acute stage of stroke along with standard T1 and T2 scans [5]. Given the availability of these scanning techniques, researchers have begun to correlate MRI-based neuroanatomical findings with functional measures, such as the National Institutes of Health Stroke Scale [12].…”

The quest for high spatial resolution diffusion‐weighted imaging of the human brain in vivo

“…Diffusion‐weighted MRI (DWI) is a unique MRI contrast that is used in the diagnosis and treatment of conditions such as stroke, toxic‐metabolic disorders, seizure, trauma, demyelination, tumors, infection, and others characterized by microstructural changes . DWI can help to detect subtle lesions, characterize tissue physiology, refine diagnosis, and monitor disease time course.…”