Diffusion weighted imaging in acute ischemic stroke: A review of its interpretation pitfalls and advanced diffusion imaging application

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Diffusion weighted imaging in acute ischemic stroke: A review of its interpretation pitfalls and advanced diffusion imaging application

• Nandakumar Nagaraja

Published:April 03, 2021DOI:https://doi.org/10.1016/j.jns.2021.117435

Highlights

• •
  DWI is useful to evaluate stroke mechanism, predict complications and outcome.
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  DWI reversal, DWI negative stroke and DWI stroke mimics are interpretation pitfalls.
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  Reversal of DWI lesion occurs in 26.5% of stroke and associated with reperfusion.
• •
  DWI negative stroke is noted in 6.8% to 21% of clinically diagnosed stroke.

Abstract

Diffusion weighted imaging (DWI) is a widely used imaging technique to evaluate patients with stroke. It can detect brain ischemia within minutes of stroke onset. However, DWI has few potential pitfalls that should be recognized during interpretation. DWI lesion could be reversible in the early hours of stroke and the entire lesion may not represent ischemic core. False negative DWI could lead to diagnosis of DWI negative stroke or to a missed stroke diagnosis. Ischemic stroke mimics can occur on DWI with non-cerebrovascular neurological conditions. In this article, the history of DWI, its clinical applications, and potential pitfalls for use in acute ischemic stroke are reviewed. Advanced diffusion imaging techniques with reference to Diffusion Kurtosis Imaging and Diffusion Tensor Imaging that has been studied to evaluate ischemic core are discussed.

Keywords

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