Diffusion-weighted magnetic resonance imaging for demonstration of cerebral infarcts

Bartylla, K.; Hagen, Thomas; Glöbel, H.; Jost, V.; Schneider, Günther

doi:10.1007/s001170050294

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…For instance, in the DWI-only studies, only 9 of 47 (Ͻ20%) mentioned that scans were interpreted by researchers blinded to clinical details or other imaging, 10 -18 and only 6 (13%) gave specific details on patient inclusions and exclusions. 10,16,17,19 -21 Only 9 studies gave details on the number (and reasons for) inadequate scans that were excluded from further analysis, 16,17,19,[21][22][23][24][25][26] although it is likely that patients with poor-quality scans were excluded from the analysis in other studies. There were no details in any of the studies on patient tolerability of the investigation (Figures 1, 2, and 3).…”

Section: General Methodological Details Of All Studiesmentioning

confidence: 99%

“…Although one study directly compared CT and DWI 10 (nϭ17), the majority of studies compared DWI to conventional MR. 15,18,25,40,[42][43][44][45][46][47] All of these studies indicated that more lesions were visible on DWI than on conventional imaging: in 5 studies, within 6 hours or less, 10,15,40,43,45 in 2 studies within 48 hours, 44,46 in 2 studies within 4 days, 18,42 and in 1 study "the time period under investigation" (8 hours to 12 days). 25 In only 2 of the studies the scans were read by observers blind to clinical details, 15,18 in only 1 study blind to other imaging, 43 and in only 1 the observers were blind to both clinical details and other imaging, 10 ie, in fewer than one third of studies purporting to show that DWI was better than conventional imaging was an attempt made to reduce bias by blinding the DWI interpretation. None mentioned whether an attempt was made to randomize the order in which the DWI and conventional imaging were performed or stated the order in which imaging was actually performed (ie, whether DWI was always performed after conventional imaging, in which case DWI would always be likely to show more lesions, or vice versa).…”

Section: Studies Of Dwi Alonementioning

confidence: 99%

“…25 In only 2 of the studies the scans were read by observers blind to clinical details, 15,18 in only 1 study blind to other imaging, 43 and in only 1 the observers were blind to both clinical details and other imaging, 10 ie, in fewer than one third of studies purporting to show that DWI was better than conventional imaging was an attempt made to reduce bias by blinding the DWI interpretation. None mentioned whether an attempt was made to randomize the order in which the DWI and conventional imaging were performed or stated the order in which imaging was actually performed (ie, whether DWI was always performed after conventional imaging, in which case DWI would always be likely to show more lesions, or vice versa).…”

Section: Keir and Wardlaw Dwi And Pi In Acute Ischemic Stroke 2725mentioning

confidence: 99%

“…47 Six of 399 studies (13%) found that in patients with multiple lesions demonstrated on MR, it was possible to distinguish new from old lesions with DWI, with the acute lesion appearing hyperintense and the old hypointense on the DWI. 16,18,25,41,48,49 Timing of scanning from onset of symptoms ranged from less than seven hours to 11 days. In only 2 studies were the scans read blinded to clinical details.…”

Section: Keir and Wardlaw Dwi And Pi In Acute Ischemic Stroke 2725mentioning

confidence: 99%

“…25,92,93 Few studies mentioned whether any of their prospectively identified patients later turned out not to have had a stroke-though it would be unusual, in a prospective sample even as small as 40, not to find the occasional patient thought initially to have had a stroke who turned out to have a nonvascular cause of the symptoms. 94 Conversely, the study by Ay et al 27 and other case reports 95,96 have highlighted the potential for DWI to be negative in patients with ischemic stroke.…”

Section: Keir and Wardlaw Dwi And Pi In Acute Ischemic Stroke 2727mentioning

confidence: 99%

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Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke

Keir

Wardlaw

2000

Stroke

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Background and Purpose-Recent advances in neuroimaging have raised hopes of early and accurate identification of ischemic brain and the discrimination of dead from salvageable tissue. We sought to determine whether the data published so far are enough to establish the roles of these techniques in everyday clinical practice. Methods-A systematic review of studies of MR diffusion-weighted imaging (DWI), perfusion imaging (PI), or a combination of the two, in human stroke, excluding abstracts and case reports. One reviewer extracted information on the size of each study, its main purpose, methodological details, and results. Results-We identified 47 studies of DWI, 18 studies of MR PI alone or in combination with another advanced imaging modality, and 19 studies of DWI and PI together. Although high proportions of the studies were prospective and gave good details of the imaging sequences used, the majority gave very limited details on patient selection and clinical characteristics or blinded imaging assessment. Pathophysiological changes were inferred from DWI/PI patterns that were not supported by other data. Conclusions-Despite considerable enthusiasm for and promise of these techniques, there is not sufficient information available in these studies to enable us to draw firm conclusions about the sensitivity and specificity of these techniques for identification of either ischemic lesions not visible by other means or salvageable tissue. Future studies should include larger numbers of carefully described patients, assess the contribution of DWI over and above other imaging, obtain follow-up at an appropriate time interval to determine accurate clinical and neuroradiological outcomes, and assess DWI/PI abnormality with reperfusion in randomized treatment trials. Investigators should also be encouraged to combine their individual patient data in meta-analyses to obtain a more robust assessment of the value of DWI and PI from larger sample sizes. Key Words: magnetic resonance imaging, diffusion-weighted Ⅲ magnetic resonance imaging, perfusion-weighted Ⅲ stroke, acute Ⅲ stroke, ischemic R ecent advances in brain imaging may likely underpin the future of stroke care. In particular, the introduction of MR and development of advanced imaging-like spectroscopy (MRS) and diffusion-weighted and perfusion imaging (DWI and PI, respectively) have raised hopes of greater ability to discriminate dead from salvageable tissue and thus to target new treatments. Several reviews 1,2 have summarized the technical aspects and possible applications of these advances, and considerable enthusiasm has been expressed for the use of these techniques in stroke; relatively few, however, have highlighted the problems that need to be overcome to maximize the potential of these exciting techniques. 3,4 DWI works on the principle that sensitizing a standard MR image to diffusion weighting identifies regions of abnormal water movement, occurring very early after onset of ischemia, resulting in increased (bright) signal intensity. 5 It is thought ...

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Section: General Methodological Details Of All Studiesmentioning

confidence: 99%

Section: Studies Of Dwi Alonementioning

confidence: 99%

Section: Keir and Wardlaw Dwi And Pi In Acute Ischemic Stroke 2725mentioning

confidence: 99%

Section: Keir and Wardlaw Dwi And Pi In Acute Ischemic Stroke 2725mentioning

confidence: 99%

Section: Keir and Wardlaw Dwi And Pi In Acute Ischemic Stroke 2727mentioning

confidence: 99%

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Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke

Keir

Wardlaw

2000

Stroke

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Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms

Brazzelli

Sandercock

Chappell

et al. 2009

Cochrane Database of Systematic Reviews

104

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DWI appears to be more sensitive than CT for the early detection of ischaemic stroke in highly selected patients. However, the variability in the quality of included studies and the presence of spectrum and incorporation biases render the reliability and generalisability of observed results questionable. Further well-designed studies without methodological biases, in more representative patient samples, with practicality and cost estimates are now needed to determine which patients should undergo MRI and which CT in suspected acute stroke.

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What Pathological Type of Stroke is it, Cerebral Ischaemia or Haemorrhage?

2008

Stroke

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Diffusion-weighted magnetic resonance imaging for demonstration of cerebral infarcts

Cited by 8 publications

References 16 publications

Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke

Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke

Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms

What Pathological Type of Stroke is it, Cerebral Ischaemia or Haemorrhage?

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