scholarly journals Diffusion-weighted Imaging Reversibility In Stroke After Successful Mechanical Recanalization. Case report

2020 ◽  
Vol 29 (2) ◽  
Author(s):  
Matías Negrotto ◽  
Alejandro M. Spiotta ◽  
Aquilla S. Turk ◽  
Raymond D. Turner ◽  
Jonathan Lena ◽  
...  
Keyword(s):  
Case Report ◽  
Clinical Outcome ◽  
Thrombolytic Therapy ◽  
Tissue Damage ◽  
Diffusion Weighted Imaging ◽  
Lesion Size ◽  
Infarct Core ◽  
Mechanical Recanalization ◽  
Diffusion Weighted ◽  
Imaging Characteristics

Increased use of Diffusion-weighted imaging (DWI) in acute stroke has led to observations of early diffusion normalization in lesions thatinitially show diffusion slowing. The “renormalization” of DWI may be spontaneous or the result of thrombolytic therapy, thus, acuteslowing of diffusion is not necessarily an indicator of irreversible tissue damage. The perfusion-diffusion mismatch concept is attractiveas it assumes that DWI lesion size reflects the infarct core whilst the mismatch area reflects the penumbra. However, this concept maybe an oversimplification. This paper shows a case with Diffusion Lesion Reversal after successful neuroendovascular treatment andexcellent clinical outcome, and discuss the imaging characteristics associated with this phenomenon.

The adjunctive value of diffusion weighted imaging in diagnosis and follow up of uterovaginal diffuse B-cell lymphoma: A case report and literature review.

2021 ◽  
Vol 17 ◽  
Author(s):  
Gehad A. Saleh ◽  
Reham Alghandour ◽  
Eman Y Rashad ◽  
Ahmed M Tawfik ◽  
Ali H. Elmokadem
Keyword(s):  
Case Report ◽  
B Cell ◽  
Diffusion Weighted Imaging ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Diagnostic Methods ◽  
Pelvic Mri ◽  
Diffusion Weighted ◽  
Large B Cell

Background: Lymphoma of the female gynecologic tract is extremely rare. Typically, lymphoma is managed non surgically unlike other non-lymphomatous malignant tumors raising the importance to differentiate between both entities. Case report: We describe the magnetic resonance imaging (MRI) features of a case of uterovaginal diffuse large B-cell lymphoma in a 50-year-old postmenopausal woman emphasizing Diffusion-Weighted Imaging (DWI) as a diagnostic and follow up tool. We reviewed the literature regarding the diagnostic methods for female genital lymphoma. Forty-five cases including our patient were reviewed with age range from 22 to 85 years. Vaginal bleeding was the most common presentation. The diagnosis was established by Papanicolaou smear, cervical biopsy (25/45), endometrial biopsy (6/45), vaginal biopsy (2/45), pelvic mass biopsy (2/45), iliac LN biopsy (1/45) and surgical diagnosis (8/45). Diffuse large B-cell lymphomas (DLBCL) constitute the vast majority of the cases (82%). The uterine cervix was involved at diagnosis in the majority of these cases (68%) while uterine body (42%) and vagina (28%) were less involved. Pelvic lymphadenopathy was found in 15 cases while extra genital lymphomatous infiltration in 13 cases. Sonographic findings were nonspecific while CT provided excellent data about extra-genital involvement. Thirteen cases underwent pelvic MRI that displayed superior detection of disease extension and parametric involvement. Diffusion restriction was reported only in one case without quantitative analysis of ADC map. Conclusion: MRI shows unique features that help to differentiate uterovaginal lymphoma from the much more common carcinomas and discriminate post-operative changes from tumor recurrence. It exhibits a marked restricted diffusion pattern with lower ADC values than carcinomas and post-operative changes.

scholarly journals e-ASPECTS derived acute ischemic volumes on non-contrast-enhanced computed tomography images

2019 ◽  
Vol 15 (9) ◽  
pp. 995-1001
Author(s):  
Simon Nagel ◽  
Olivier Joly ◽  
Johannes Pfaff ◽  
Panagiotis Papanagiotou ◽  
Klaus Fassbender ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Outcome ◽  
Diffusion Weighted Imaging ◽  
Clinical Severity ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Computed Tomography Perfusion ◽  
Computed Tomography Images ◽  
Diffusion Weighted ◽  
Ischemic Core

Background and purpose Validation of automatically derived acute ischemic volumes (AAIV) from e-ASPECTS on non-contrast computed tomography (NCCT). Materials and methods Data from three studies were reanalyzed with e-ASPECTS Version 7. AAIV was calculated in milliliters (ml) in all scored ASPECTS regions of the hemisphere detected by e-ASPECTS. The National Institute of Health Stroke Scale (NIHSS) determined stroke severity at baseline and clinical outcome was measured with the modified Rankin Scale (mRS) between 45 and 120 days. Spearman ranked correlation coefficients (R) of AAIV and e-ASPECTS scores with NIHSS and mRS as well as Pearson correlation of AAIV with diffusion-weighted imaging and CT perfusion-estimated ischemic “core” volumes were calculated. Multivariate regression analysis (odds ratio, OR with 95% confidence intervals, CI) and Bland–Altman plots were performed. Results We included 388 patients. Mean AAIV was 11.6 ± 18.9 ml and e-ASPECTS was 9 (8–10: median and interquartile range). AAIV, respectively e-ASPECTS correlated with NIHSS at baseline (R = 0.35, p < 0.001; R = −0.36, p < 0.001) and follow-up mRS (R = 0.29, p < 0.001; R = −0.3, p < 0.001). In subsets of patients, AAIV correlated strongly with diffusion-weighted imaging ( n = 37, R = 0.68, p < 0.001) and computed tomography perfusion-derived ischemic “core” ( n = 41, R = 0.76, p < 0.001) lesion volume and Bland–Altman plots showed a bias close to zero (−2.65 ml for diffusion-weighted imaging and 0.45 ml forcomputed tomography perfusion “core”). Within the whole cohort, the AAIV (OR 0.98 per ml, 95% CI 0.96–0.99) and e-ASPECTS scores (OR 1.3, 95%CI 1.07–1.57) were independent predictors of good outcome Conclusion AAIV on NCCT correlated moderately with clinical severity but strongly with diffusion-weighted imaging lesion and computed tomography perfusion ischemic “core” volumes and predicted clinical outcome.

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

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.

Diffusion-weighted imaging abnormalities in the corpus callosum after neonatal seizure: A case report

2008 ◽  
Vol 30 (3) ◽  
pp. 215-217 ◽  
Author(s):  
Tetsuo Kubota ◽  
Hiroyuki Kidokoro ◽  
Miharu Ito ◽  
Hideyuki Oe ◽  
Tetsuo Hattori ◽  
...  
Keyword(s):  
Case Report ◽  
Corpus Callosum ◽  
Diffusion Weighted Imaging ◽  
Neonatal Seizure ◽  
Diffusion Weighted

Clinical diffusion mismatch better discriminates infarct growth than mean transit time–diffusion weighted imaging mismatch in patients with middle cerebral artery–M1 occlusion and limited infarct core

2016 ◽  
Vol 9 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Raul G Nogueira ◽  
Andre Kemmling ◽  
Leticia M Souza ◽  
Seyedmehdi Payabvash ◽  
Joshua A Hirsch ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Transit Time ◽  
Cerebral Artery ◽  
Diffusion Weighted Imaging ◽  
Mean Transit Time ◽  
Stroke Patients ◽  
Infarct Core ◽  
Nihss Score ◽  
Diffusion Weighted ◽  
Small Infarct

Background and purposeOur purpose was to compare clinical diffusion mismatch (CDM) and mean transit time (MTT)-diffusion mismatch as predictors of infarct growth in patients with proximal middle cerebral artery (MCA) occlusion and small infarct core on presentation.MethodsRetrospective analysis of consecutive stroke patients with: (1) MCA-M1 occlusion; (2) MRI performed ≤10 h from symptoms onset; and (3) baseline MRI-diffusion weighted imaging (DWI) volume ≤25 mL. Definitions included: CDM=baseline National Institutes of Health Stroke Scale (NIHSS) score ≥8 and DWI volume ≤25 mL; MTT-DWI mismatch=visually assessed unthresholded MTT lesion ((MTT-DWI))/DWI) ≥20% and ≥10 mL larger than the DWI lesion; and significant infarct growth (>20% (≥5 mL) increase in infarct volume on follow-up). Uni-/multivariate analyses were performed to define the predictors of infarct growth.Results63 stroke patients with MCA-M1 occlusions and MRI within 10 h of onset were evaluated. 20 patients were excluded on the basis of DWI volume >25 mL leaving 43 patients (mean age 75.8 years; median NIHSS=13) in the study cohort. On univariate analysis, larger admission DWI volume (p<0.0001), baseline NIHSS score ≥8 (p=0.001), lack of IV and/or endovascular treatment (p=0.021), glucose levels >125 mg/dL (p=0.024), poor CT angiography collaterals (p=0.046), and lower admission Alberta Stroke Program Early CT score (ASPECTS) (p=0.049) predicted infarct growth. Baseline NIHSS score ≥8 was the only independent predictor of stroke growth in the multivariate analysis (p=0.001). All patients had MTT-DWI mismatch >20%. There was no significant association between the amount of MTT-DWI mismatch and infarct growth (p=0.33).ConclusionsCDM is the most powerful predictor of infarct growth in patients with MCA-M1 occlusion and small infarct core. Most of these patients will have a significant oligemic MTT lesion regardless of admission NIHSS score.

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