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

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.

Predicting functional outcome in patients with acute brainstem infarction using deep neuroimaging features

“…Diffusion-weighted imaging (DWI) has high sensitivity and specificity in detecting ischemic lesions, and it can facilitate diagnosis and provide important information associated with prognosis for brainstem infarction [11]. In previous imaging studies, the number and distribution of DWI lesions have been shown to offer vital clues to the underlying stroke mechanisms and prognosis of patients with infratentorial strokes [12,13].…”