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Förster A, Ramos A, Wenz H, Groden C, Alonso A. Computed diffusion-weighted imaging in patients with transient neurovascular symptoms with and without ischemic infarction. J Neuroradiol 2024; 51:1-4. [PMID: 36868372 DOI: 10.1016/j.neurad.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Detection of ischemic lesions in patients with transient neurovascular symptoms is relevant for the estimation of the risk of a subsequent stroke and etiological classification. To improve detection rates, different technical approaches have been used, such as diffusion-weighted imaging (DWI) with high b-values or higher magnetic field strength. Here, we sought to investigate the value of computed DWI (cDWI) with high b-values in these patients. METHODS From an MRI report database we identified patients with transient neurovascular symptoms who underwent repeated MRI including DWI. cDWI was calculated with a monoexponential model with high b-values (2000, 3000, and 4000 s/mm2) and compared to the routinely used standard DWI with regard to presence of ischemic lesions and lesion detectability. RESULT Overall 33 patients with transient neurovascular symptoms (71 [IQR 57-83.5] years; 21 [63.6%] male) were included. On DWI, acute ischemic lesions were observed in 22 (78.6%). Acute ischemic lesions were observed in 17 (51.5%) patients on initial DWI, and in 26 (78.8%) patients on follow-up DWI. Lesion detectability was rated significantly better on cDWI at 2000s/mm2 compared to standard DWI. In 2 (9.1%) patients, cDWI at 2000s/mm2 revealed an acute ischemic lesion proven on follow-up standard DWI which was not detected with certainty on the initial standard DWI. CONCLUSION cDWI might be a valuable addition to routinely acquired standard DWI in patients with transient neurovascular symptoms since its use might result in improved ischemic lesion detection. A b-value of 2000s/mm2 seems most promising for clinical practice.
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Affiliation(s)
- A Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Ana Ramos
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - H Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - C Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - A Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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Lee SH, Aw KL, McVerry F, McCarron MO. Systematic Review and Meta-Analysis of Diagnostic Agreement in Suspected TIA. Neurol Clin Pract 2021; 11:57-63. [PMID: 33968473 DOI: 10.1212/cpj.0000000000000830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
Objective To determine the interrater variability for TIA diagnostic agreement among expert clinicians (neurologists/stroke physicians), administrative data, and nonspecialists. Methods We performed a meta-analysis of studies from January 1984 to January 2019 using MEDLINE, EMBASE, and PubMed. Two reviewers independently screened for eligible studies and extracted interrater variability measurements using Cohen's kappa scores to assess diagnostic agreement. Results Nineteen original studies consisting of 19,421 patients were included. Expert clinicians demonstrate good agreement for TIA diagnosis (κ = 0.71, 95% confidence interval [CI] = 0.62-0.81). Interrater variability between clinicians' TIA diagnosis and administrative data also demonstrated good agreement (κ = 0.68, 95% CI = 0.62-0.74). There was moderate agreement (κ = 0.41, 95% CI = 0.22-0.61) between referring clinicians and clinicians at TIA clinics receiving the referrals. Sixty percent of 748 patient referrals to TIA clinics were TIA mimics. Conclusions Overall agreement between expert clinicians was good for TIA diagnosis, although variation still existed for a sizeable proportion of cases. Diagnostic agreement for TIA decreased among nonspecialists. The substantial number of patients being referred to TIA clinics with other (often neurologic) diagnoses was large, suggesting that clinicians, who are proficient in managing TIAs and their mimics, should run TIA clinics.
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Affiliation(s)
- Seong Hoon Lee
- School of Medicine, Dentistry and Biomedical Sciences (SHL, KLA), Queen's University Belfast, Belfast; and Department of Neurology (FM, MOM), Altnagelvin Hospital, Derry, United Kingdom
| | - Kah Long Aw
- School of Medicine, Dentistry and Biomedical Sciences (SHL, KLA), Queen's University Belfast, Belfast; and Department of Neurology (FM, MOM), Altnagelvin Hospital, Derry, United Kingdom
| | - Ferghal McVerry
- School of Medicine, Dentistry and Biomedical Sciences (SHL, KLA), Queen's University Belfast, Belfast; and Department of Neurology (FM, MOM), Altnagelvin Hospital, Derry, United Kingdom
| | - Mark O McCarron
- School of Medicine, Dentistry and Biomedical Sciences (SHL, KLA), Queen's University Belfast, Belfast; and Department of Neurology (FM, MOM), Altnagelvin Hospital, Derry, United Kingdom
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Nagaraja N. Diffusion weighted imaging in acute ischemic stroke: A review of its interpretation pitfalls and advanced diffusion imaging application. J Neurol Sci 2021; 425:117435. [PMID: 33836457 DOI: 10.1016/j.jns.2021.117435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/08/2021] [Accepted: 04/02/2021] [Indexed: 12/28/2022]
Abstract
Diffusion weighted imaging (DWI) is a widely used imaging technique to evaluate patients with stroke. It can detect brain ischemia within minutes of stroke onset. However, DWI has few potential pitfalls that should be recognized during interpretation. DWI lesion could be reversible in the early hours of stroke and the entire lesion may not represent ischemic core. False negative DWI could lead to diagnosis of DWI negative stroke or to a missed stroke diagnosis. Ischemic stroke mimics can occur on DWI with non-cerebrovascular neurological conditions. In this article, the history of DWI, its clinical applications, and potential pitfalls for use in acute ischemic stroke are reviewed. Advanced diffusion imaging techniques with reference to Diffusion Kurtosis Imaging and Diffusion Tensor Imaging that has been studied to evaluate ischemic core are discussed.
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Affiliation(s)
- Nandakumar Nagaraja
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
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Edlow BL, Hurwitz S, Edlow JA. Diagnosis of DWI-negative acute ischemic stroke: A meta-analysis. Neurology 2017; 89:256-262. [PMID: 28615423 DOI: 10.1212/wnl.0000000000004120] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of diffusion-weighted imaging (DWI)-negative acute ischemic stroke (AIS) and to identify clinical characteristics of patients with DWI-negative AIS. METHODS We systematically searched PubMed and Ovid/MEDLINE for relevant studies between 1992, the year that the DWI sequence entered clinical practice, and 2016. Studies were included based upon enrollment of consecutive patients presenting with a clinical diagnosis of AIS prior to imaging. Meta-analysis was performed to synthesize study-level data, estimate DWI-negative stroke prevalence, and estimate the odds ratios (ORs) for clinical characteristics associated with DWI-negative stroke. RESULTS Twelve articles including 3,236 AIS patients were included. The meta-analytic synthesis yielded a pooled prevalence of DWI-negative AIS of 6.8%, 95% confidence interval (CI) 4.9-9.3. In the 5 studies that reported proportion data for DWI-negative and DWI-positive AIS based on the ischemic vascular territory (n = 1,023 AIS patients), DWI-negative stroke was strongly associated with posterior circulation ischemia, as determined by clinical diagnosis at hospital discharge or repeat imaging (OR 5.1, 95% CI 2.3-11.6, p < 0.001). CONCLUSIONS A small but significant percentage of patients with AIS have a negative DWI scan. Patients with neurologic deficits consistent with posterior circulation ischemia have 5 times the odds of having a negative DWI scan compared to patients with anterior circulation ischemia. AIS remains a clinical diagnosis and urgent reperfusion therapy should be considered even when an initial DWI scan is negative.
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Affiliation(s)
- Brian L Edlow
- From the Department of Neurology (B.L.E.) and Athinoula A. Martinos Center for Biomedical Imaging (B.L.E.), Massachusetts General Hospital, Department of Medicine (S.H.), Brigham and Women's Hospital, and Department of Emergency Medicine (J.A.E.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Shelley Hurwitz
- From the Department of Neurology (B.L.E.) and Athinoula A. Martinos Center for Biomedical Imaging (B.L.E.), Massachusetts General Hospital, Department of Medicine (S.H.), Brigham and Women's Hospital, and Department of Emergency Medicine (J.A.E.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jonathan A Edlow
- From the Department of Neurology (B.L.E.) and Athinoula A. Martinos Center for Biomedical Imaging (B.L.E.), Massachusetts General Hospital, Department of Medicine (S.H.), Brigham and Women's Hospital, and Department of Emergency Medicine (J.A.E.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Gory B, Sivan-Hoffmann R, Riva R, Labeyrie PE, Eldesouky I, Sadeh-Gonike U, Signorelli F, Turjman F. DWI lesions reversal in posterior circulation stroke after reperfusion: Two illustrative cases and review of the literature. J Neuroradiol 2015; 42:184-7. [DOI: 10.1016/j.neurad.2015.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/23/2015] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
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Souillard-Scemama R, Tisserand M, Calvet D, Jumadilova D, Lion S, Turc G, Edjlali M, Mellerio C, Lamy C, Naggara O, Meder JF, Oppenheim C. An update on brain imaging in transient ischemic attack. J Neuroradiol 2015; 42:3-11. [DOI: 10.1016/j.neurad.2014.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
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MR screening of candidates for thrombolysis: How to identify stroke mimics? J Neuroradiol 2014; 41:283-95. [PMID: 25451670 DOI: 10.1016/j.neurad.2014.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 11/21/2022]
Abstract
Stroke mimics account for up to a third of suspected strokes. The main causes are epileptic deficit, migraine aura, hypoglycemia, and functional disorders. Accurate recognition of stroke mimics is important for adequate identification of candidates for thrombolysis. This decreases the number of unnecessary treatments and invasive vascular investigations. Correctly identifying the cause of symptoms also avoids delaying proper care. Therefore, this pictorial review focuses on what the radiologist should know about the most common MRI patterns of stroke mimics in the first hours after onset of symptoms. The issues linked to the accurate diagnosis of stroke mimics in the management of candidates for thrombolysis will be discussed.
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Amarteifio E, Essig M, Böckler D, Attigah N, Schuster L, Demirel S. Comparison of gadofosveset (Vasovist(®)) with gadobenate dimeglumine (Multihance(®))-enhanced MR angiography for high-grade carotid artery stenosis. J Neuroradiol 2014; 42:236-44. [PMID: 24996569 DOI: 10.1016/j.neurad.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prove superiority of blood pool contrast agent gadofosveset over conventional contrast agent gadobenate dimeglumine for assessment of stenotic internal carotid artery (ICA). METHODS Eleven patients with high-grade ICA stenosis (≥75%), confirmed by duplex sonography, underwent MR angiography (MRA) with gadofosveset and gadobenate dimeglumine. RESULTS Agreement in stenosis grade was reached in 7 of 10 stenotic ICAs. In two ICAs, gadobenate dimeglumine led to underestimation of stenosis grade. There was a significant difference in signal intensity (pre-/post-stenotic segments), showing higher values for gadofosveset (P<0.01; P<0.05). Impression of contrast intensity with gadofosveset was better in 8 ICAs and only in 1 ICA with gadobenate dimeglumine (P<0.05). CONCLUSION Gadofosveset-enhanced MR angiography may be superior for assessment of high-grade ICA stenosis compared with gadobenate dimeglumine MR angiography.
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Affiliation(s)
- E Amarteifio
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - M Essig
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, MB R3T 2N2 Manitoba, Winnipeg, Canada
| | - D Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - N Attigah
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - L Schuster
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - S Demirel
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
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