Key result
Initial DWI misses acute infarcts in ~26% of stroke and TIA presentations.
Cohort (n=401)
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BACKGROUND AND PURPOSE: The frequency of DWI negative cerebral ischemia and clinical factors associated with such a circumstance is not well understood. METHODS: We performed MRI including diffusion-weighted imaging (DWI) in patients with stroke and transient ischemic attack (TIA) within 24 hours of symptom onset and again at 30 days. RESULTS: Of 401 patients, 103 (25.6%) had an initial negative DWI study. In the DWI negative group, among the stroke patients, 6/26 (23.1%) had infarcts on follow-up MRI (4 lacunar and 2 posterior circulation syndromes) and 1 had a rMTT deficit. Among the TIA patients, 4/63 (6.3%) showed rMTT deficits and 2/63 (3.2%) had infarcts on follow-up MRI. CONCLUSIONS: Baseline perfusion weighted imaging sequences may detect ischemia in a small proportion of DWI negative cases. Only those with brain stem location or lacunar syndrome were DWI negative initially and yet had a follow-up imaging confirmation of infarct or a final clinical diagnosis of stroke.
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Sylaja et al. (2008) conducted a cohort in Stroke and Transient Ischemic Attack (TIA) (n=401). Initial negative Diffusion-Weighted Imaging (DWI) was evaluated on Initial negative DWI rate and follow-up MRI infarct confirmation. Initial negative DWI occurred in 25.6% of 401 stroke/TIA patients, with follow-up MRI confirming infarcts in 23.1% of the negative-DWI stroke subgroup and 3.2% of the TIA subgroup.
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