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

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Diffusion Magnetic Resonance Imaging
Brain Ischemia
Tomography
Stroke
Leukoaraiosis
Transient Ischemic Attack
Ischemia

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Diffusion-weighted MRI in patients with non-diagnostic CT in the post-acute phase of cerebral ischemia. / Totaro, P.; Toni, D.; Durastanti, L.; Bozzao, L.; Gualdi, G. F.; Raz, E.; Kouleridou, A.; Pantano, P.

In: European Neurology, Vol. 63, No. 2, 02.2010, p. 94-100.

Research output: Contribution to journalArticle

Totaro, P, Toni, D, Durastanti, L, Bozzao, L, Gualdi, GF, 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, vol. 63, no. 2, pp. 94-100. https://doi.org/10.1159/000276399
Totaro, P. ; Toni, D. ; Durastanti, L. ; Bozzao, L. ; Gualdi, G. F. ; Raz, E. ; Kouleridou, A. ; Pantano, P. / Diffusion-weighted MRI in patients with non-diagnostic CT in the post-acute phase of cerebral ischemia. In: European Neurology. 2010 ; Vol. 63, No. 2. pp. 94-100.
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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.",
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AU - Totaro, P.

AU - Toni, D.

AU - Durastanti, L.

AU - Bozzao, L.

AU - Gualdi, G. F.

AU - Raz, E.

AU - Kouleridou, A.

AU - Pantano, P.

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AB - 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.

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KW - Leukoaraiosis

KW - Non-diagnostic CT

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