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(Radiology. 1999;210:155-162.)
© RSNA, 1999

Neuroradiology

Diffusion-weighted MR Imaging: Diagnostic Accuracy in Patients Imaged within 6 Hours of Stroke Symptom Onset

R. Gilberto González, MD, PhD1, Pamela W. Schaefer, MD1, Ferdinando S. Buonanno, MD1, Lee H. Schwamm, MD1, Ronald F. Budzik, MD1, Guy Rordorf, MD1, Bing Wang, MS1, A. Gregory Sorensen, MD1 and Walter J. Koroshetz, MD1

1 Division of Neuroradiology and Stroke Service, Massachusetts General Hospital and Harvard Medical School, GRB 285, Fruit St, Boston, MA 02114-2696.

PURPOSE: To evaluate the diagnostic accuracy of diffusion-weighted magnetic resonance (MR) imaging performed within 6 hours of the onset of stroke symptoms.

MATERIALS AND METHODS: The authors reviewed the patient records and images from all patients hospitalized in a 10-month period in whom diffusion-weighted imaging was performed within 6 hours of the onset of strokelike symptoms (n = 22). Analyses included comparison of the initial interpretation of the diffusion-weighted images with the final clinical diagnosis; blinded reviews of computed tomographic (CT) scans and conventional and diffusion-weighted images; and determination of lesion contrast-to-noise ratios (CNRs).

RESULTS: Diffusion-weighted images indicated stroke in 14 patients, all of whom had a final diagnosis of acute stroke. Diffusion-weighted images were negative in eight patients, all of whom had a final clinical diagnosis other than stroke (100% sensitivity, 100% specificity, {chi}2 = 23.00, P < .0001). Blinded reviews yielded 100% sensitivity and 86% specificity for diffusion-weighted MR imaging ({chi}2 = 15.43, P < .0005); 18% sensitivity and 100% specificity for conventional MR imaging ({chi}2 = 2.85, P > .2); and 45% sensitivity and 100% specificity for CT ({chi}2 = 4.40, P > .10). Lesion percentage CNRs were 77% for diffusion-weighted imaging, 5.5% for CT, 9.8% for T2-weighted MR imaging, and 3.1% for proton-density–weighted MR imaging (P < .002 for diffusion-weighted imaging vs others).

CONCLUSION: Diffusion-weighted MR imaging is highly accurate for diagnosing stroke within 6 hours of symptom onset and is superior to CT and conventional MR imaging.

Index terms: Brain, ischemia, 13.781 • Brain, MR, 13.121411, 13.12144 • Magnetic resonance (MR), comparative studies, 13.1211, 13.121411, 13.12144 • Magnetic resonance (MR), diffusion study, 13.12144




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