Diffusion-weighted MRI in patients with non-diagnostic CT in the post-acute phase of cerebral ischemia

P. Totaro, D. Toni, L. Durastanti, L. Bozzao, G. F. Gualdi, E. Raz, A. Kouleridou, P. Pantano

Research output: Contribution to journalArticle

Abstract

Background: Unenhanced computed tomography (CT) is the imaging technique used in acute stroke. In some cases it is unable to detect damage even 24-48 h after symptom onset. The aim of our work was to evaluate the diagnostic value of diffusion-weighted imaging (DWI) in the post-acute phase of cerebral ischemia in patients in whom CT did not yield a definitive diagnosis. Methods: We retrospectively evaluated DWI findings in 214 patients, out of a series of 1,680 patients admitted to our hospital following the acute onset of focal neurological symptoms, in whom non-contrast CT, performed within 30 h of symptom onset, was normal (123), incongruous, i.e. a marked hypodensity indicative of an old infarct or a slight hypodensity not consistent with the clinical findings (66), or leukoaraiotic, i.e. diffuse chronic hypodensities in the periventricular white matter (25). Results: DWI showed signs of recent brain ischemia in 125/214 (58%) patients: 64/123 (52%) with a normal CT, 41/66 (62%) with an incongruous CT, and 20/25 (80%) with leukoaraiosis (p = 0.027). Multiple lesions were detected in 16/125 (16%) patients, while single lesions were ≤2 cm in 83/109 (76%) cases. DWI showed signs of ischemia in 22/91 (24%) patients with TIA and in 103/123 (84%) patients with stroke (p = 0.0001). Conclusion: In a quite high proportion of patients with recent symptoms of transient ischemic attack/ischemic stroke and a repeat non-diagnostic CT, DWI may help in the diagnosis of ischemic stroke and in shedding light on the underlying pathogenic mechanism.

Original languageEnglish
Pages (from-to)94-100
Number of pages7
JournalEuropean Neurology
Volume63
Issue number2
DOIs
Publication statusPublished - Feb 2010

Keywords

  • Cerebral ischemia
  • Cerebral ischemia, post-acute phase
  • Diffusion-weighted imaging
  • Leukoaraiosis
  • Non-diagnostic CT

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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    Totaro, P., Toni, D., Durastanti, L., Bozzao, L., Gualdi, G. F., Raz, E., Kouleridou, A., & Pantano, P. (2010). Diffusion-weighted MRI in patients with non-diagnostic CT in the post-acute phase of cerebral ischemia. European Neurology, 63(2), 94-100. https://doi.org/10.1159/000276399