Failure of diffusion-weighted imaging in intraoperative 3 Tesla MRI to identify hyperacute strokes during glioma surgery

AbstractIntraoperatively acquired diffusion-weighted imaging (DWI) sequences in cranial tumor surgery are used for early detection of ischemic brain injuries, which could result in impaired neurological outcome and their presence might thus influence the neurosurgeon’s decision on further resection. The phenomenon of false-negative DWI findings in intraoperative magnetic resonance imaging (ioMRI) has only been reported in single cases and therefore yet needs to be further analyzed. This retrospective single-center study’s objective was the identification and characterization of false-negative DWI findings in ioMRI with new or enlarged ischemic areas on postoperative MRI (poMRI). Out of 225 cranial tumor surgeries with intraoperative DWI sequences, 16 cases with no additional resection after ioMRI and available in-time poMRI (< 14 days) were identified. Of these, a total of 12 cases showed false-negative DWI in ioMRI (75%). The most frequent tumor types were oligodendrogliomas and glioblastomas (4 each). In 5/12 cases (41.7%), an ischemic area was already present in ioMRI, however, volumetrically increased in poMRI (mean infarct growth + 2.1 cm3; 0.48–3.6), whereas 7 cases (58.3%) harbored totally new infarcts on poMRI (mean infarct volume 0.77 cm3; 0.05–1.93). With this study we provide the most comprehensive series of false-negative DWI findings in ioMRI that were not followed by additional resection. Our study underlines the limitations of intraoperative DWI sequences for the detection and size-estimation of hyperacute infarction. The awareness of this phenomenon is crucial for any neurosurgeon utilizing ioMRI.

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Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke

International Journal of Stroke ◽

10.1177/1747493016666089 ◽

2016 ◽

Vol 11 (9) ◽

pp. 1028-1035 ◽

Cited By ~ 10

Author(s):

Adam Kirton ◽

Elizabeth Williams ◽

Michael Dowling ◽

Sarah Mah ◽

Jacquie Hodge ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Diffusion Weighted Imaging ◽

Infarct Volume ◽

Resonance Imaging ◽

Arterial Ischemic Stroke ◽

Diffusion Weighted ◽

Motor Outcome

Background Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome. Aim/hypothesis We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome. Methods This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5–14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging ( b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann–Whitney test). Results Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes ( p = 0.03). Corticospinal tract diaschisis was associated with motor outcome ( p = 0.004). Method reliability was excellent. Conclusions Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.

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The Rate of Apparent Diffusion Coefficient Change With Diffusion Time on Breast Diffusion-Weighted Imaging Depends on Breast Tumor Types and Molecular Prognostic Biomarker Expression

Investigative Radiology ◽

10.1097/rli.0000000000000766 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Mami Iima ◽

Masako Kataoka ◽

Maya Honda ◽

Akane Ohashi ◽

Ayami Ohno Kishimoto ◽

...

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Breast Tumor ◽

Diffusion Weighted Imaging ◽

Prognostic Biomarker ◽

Diffusion Time ◽

Diffusion Weighted ◽

Apparent Diffusion ◽

Tumor Types

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Qualitative Posttreatment Diffusion-Weighted Imaging as a Predictor of 90-day Outcome in Stroke Intervention

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.330 ◽

2019 ◽

Vol 47 (2) ◽

pp. 160-166

Author(s):

Adam A Dmytriw ◽

Abdullah Alrashed ◽

Alejandro Enriquez-Marulanda ◽

Shadi Daghighi ◽

Ghouth Waggas ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Infarct Volume ◽

Multivariable Analysis ◽

Poor Performance ◽

Recombinant Tissue Plasminogen Activator ◽

National Institutes Of Health ◽

Infarct Core ◽

Vessel Occlusion ◽

Subjective Impression ◽

Diffusion Weighted

ABSTRACT:Purpose:The aim was to assess the ability of post-treatment diffusion-weighted imaging (DWI) to predict 90-day functional outcome in patients with endovascular therapy (EVT) for large vessel occlusion in acute ischemic stroke (AIS).Methods:We examined a retrospective cohort from March 2016 to January 2018, of consecutive patients with AIS who received EVT. Planimetric DWI was obtained and infarct volume calculated. Four blinded readers were asked to predict modified Rankin Score (mRS) at 90 days post-thrombectomy.Results:Fifty-one patients received endovascular treatment (mean age 65.1 years, median National Institutes of Health Stroke Scale (NIHSS) 18). Mean infarct volume was 43.7 mL. The baseline NIHSS, 24-hour NIHSS, and the DWI volume were lower for the mRS 0–2 group. Also, the thrombolysis in cerebral infarction (TICI) 2b/3 rate was higher in the mRS 0–2 group. No differences were found in terms of the occlusion level, reperfusion technique, or recombinant tissue plasminogen activator use. There was a significant association noted between average infarct volume and mRS at 90 days. On multivariable analysis, higher infarct volume was significantly associated with 90-day mRS 3–5 when adjusted to TICI scores and occlusion location (OR 1.01; CI 95% 1.001–1.03; p = 0.008). Area under curve analysis showed poor performance of DWI volume reader ability to qualitatively predict 90-day mRS.Conclusion:The subjective impression of DWI as a predictor of clinical outcome is poorly correlated when controlling for premorbid status and other confounders. Qualitative DWI by experienced readers both overestimated the severity of stroke for patients who achieved good recovery and underestimated the mRS for poor outcome patients. Infarct core quantitation was reliable.

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LIMITATIONS OF DIFFUSION-WEIGHTED IMAGING IN THE DIAGNOSIS OF POSTOPERATIVE INFECTIONS

Neurosurgery ◽

10.1227/01.neu.0000311349.25281.bd ◽

2008 ◽

Vol 62 (3) ◽

pp. 577-583 ◽

Cited By ~ 18

Author(s):

Christopher J. Farrell ◽

Brian L. Hoh ◽

Mary L. Pisculli ◽

John W. Henson ◽

Fred G. Barker ◽

...

Keyword(s):

False Positive ◽

Diffusion Weighted Imaging ◽

Postoperative Infection ◽

False Negative ◽

False Negative Rate ◽

Restricted Diffusion ◽

Postoperative Infections ◽

Negative Rate ◽

Diffusion Weighted ◽

Diagnosis Of Infection

Abstract OBJECTIVE Diffusion-weighted imaging (DWI) has assumed a rapidly emerging role in the diagnosis of intracranial infection; however, its usefulness in the recognition of postoperative infection has been largely unexplored. We sought to determine the ability of DWI to accurately detect a broad range of postneurosurgical infections as well as identify individual factors that may limit its applicability. METHODS We retrospectively identified 65 patients who had undergone surgery for the confirmed diagnosis of infection between August 2001 and February 2005 and had received preoperative magnetic resonance imaging evaluation, including DWI. Fifty patients developed infections after a primary neurosurgical procedure (“postoperative” infections), whereas 15 infections occurred without antecedent intervention (“spontaneous” infections). Logistic regression analysis was used to identify factors associated with false-negative DWI findings. Additionally, we investigated the false-positive rate of DWI by retrospectively reviewing a series of 30 consecutive patients who underwent craniotomy and received postoperative DWI. RESULTS Spontaneously developing cranial infections exhibited evidence of restricted diffusion in 14 out of 15 (93%) patients; however, infections that occurred postoperatively were associated with a significant false-negative rate using DWI (36%; P < 0.01). Within the subset of patients with postoperative infection, location of infection significantly correlated with the DWI false-negative rate. Infections located extradurally were less likely to demonstrate restricted diffusion compared with those located primarily within the subdural or intraparenchymal spaces. Additionally, false-positive DWI findings were observed in 11 of the 30 patients (37%) who had DWI obtained postoperatively in the absence of infection. CONCLUSION Utilization of DWI for the diagnosis of infection after primary neurosurgical intervention is associated with an elevated false-negative rate. The absence of restricted diffusion is not sufficient to exclude the presence of pyogenic postcraniotomy infection and should not be used as the principle determinant of patient management in this clinical setting.

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