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ROLE OF DIFFUSION WEIGHTED IMAGING (DWI) IN EVALUATION OF ISCHEMIC STROKE: A PROSPECTIVE STUDY

Mohit Agrawal, Ajad Sarawagi, S. Shivram, G. J. Makwana

Abstract


In this prospective study of 200 cases of suspected ischemic, DWI was mainstay sequence. Most commonly involved patients were in 5th and 6th decade of life, and most presented with hemiparesis. Overall the most common arterial territory involved was MCA (55.75%). DWI was diagnostic in all 7 hyperacute cases thus having a 100% detection rate. They showed increasing hyperintensity with increase in b value from 0 to 1000 and corresponding loss of signal on ADC maps. FLAIR detected only one hyperacute case and its conspicuity was far lower than DWI. T1WI and T2WI were false negative in all hyperacute cases. All acute infarct were positive on DWI and FLAIR. T2WI and T1WI were positive in 168 and 139 acute cases respectively.

 

All subacute cases were positive on FLAIR, T2WI, and T1WI. DWI was positive in 18 of 20 subacute cases. DWI was false negative in cases of late subacute infarction due to “pseudonormalization”. All chronic infarcts were positive on all sequences. Thus for hyperacute infarcts, T1WI and T2W were not positive, subtle changes can be seen but these changes were not at all affirmative. FLAIR had sensitivity of 8.3% in detecting hyperacute infarct. DWI with ADC was 100% sensitive in diagnosing hyperacute infarct. FLAIR and DWI were 100% sensitive in detecting acute infarcts lesions but conspicuity of infarcts detected on DWI with ADC were higher than on FLAIR. T2WI and T1WI were sensitive in 90.3% and 75.8% acute cases respectively. In subacute infarcts, T1WI, T2WI and FLAIR were 100% sensitive but DWI with ADC was sensitive in 90% of cases because of pseudonormalization. In chronic infarcts all sequences were positive. 

Acute infarcts (119 cases with 186 lesions) were all positive on DWI (100%) as restricted diffusion represented as hypo intensity and corresponding hyper intensity on ADC maps. FLAIR was also positive in all acute cases (100%). T1 WI & T2 WI were positive in 74.7% & 90.9% Lesions, respectively. Sub acute infract 20 cases 37 lesions were all positive on FLAIR & T2WI representing as hyper intense signal. DWI was positive in all cases as hypo to instance signal. DWI was positive in 18 cases (90%) and 34 out of 37 lesions (91.8%), as restricted diffusion with corresponding hypo intensity on ADC maps. In 2 cases of late sub acute infraction, DWI show iso to mild hyper intensity with hyper intensity on ADC indicating increased diffusion, due to “T2 shine through” known as pseudo normalization.


Keywords


DWI, Ischemic stroke, Diffusion weighted imaging, Stroke, Etiology, Role of DWI.

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References


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