Audit of a Policy of Magnetic Resonance Imaging with Diffusion-weighted Imaging as First-line Neuroimaging for In-patients with Clinically Suspected Acute Stroke

Buckley, Brendan; Wainwright, Andrew; Meagher, Tom; Briley, Dennis

doi:10.1016/s0009-9260(02)00463-4

Cited by 39 publications

(24 citation statements)

References 13 publications

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“…Although studies have overcome the usual logistical obstacles to the emergency use of MRI, 19,20 doubts remain regarding the feasibility, practicality, and validity of stroke MRI in the clinical setting. As there is no true imaging gold standard for acute ischemic stroke that has been established by comparison with neuropathologic findings, 21 the reference diagnosis of ischemic stroke in most MRI studies is established using a follow-up lesion on CT or conventional MR images consistent with the clinical syndrome and a comprehensive diagnostic workup.…”

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confidence: 99%

Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke [RETIRED]

et al. 2010

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Objective: To assess the evidence for the use of diffusion-weighted imaging (DWI) and perfusionweighted imaging (PWI) in the diagnosis of patients with acute ischemic stroke. Methods:We systematically analyzed the literature from 1966 to January 2008 to address the diagnostic and prognostic value of DWI and PWI.Results and Recommendations: DWI is established as useful and should be considered more useful than noncontrast CT for the diagnosis of acute ischemic stroke within 12 hours of symptom onset. DWI should be performed for the most accurate diagnosis of acute ischemic stroke (Level A); however, the sensitivity of DWI for the diagnosis of ischemic stroke in a general sample of patients with possible acute stroke is not perfect. The diagnostic accuracy of DWI in evaluating cerebral hemorrhage is outside the scope of this guideline. On the basis of Class II and III evidence, baseline DWI volumes probably predict baseline stroke severity in anterior territory stroke (Level B) but possibly do not in vertebrobasilar artery territory stroke (Level C). Baseline DWI lesion volumes probably predict (final) infarct volumes (Level B) and possibly predict early and late clinical outcome measures (Level C). Baseline PWI volumes predict to a lesser degree the baseline stroke severity compared with DWI (Level C). There is insufficient evidence to support or refute the value of PWI in diagnosing acute ischemic stroke (Level U). Neurology ® 2010;75:177-185 GLOSSARY ADC ϭ apparent diffusion coefficient; ASPECTS ϭ Alberta Stroke Program Early CT Score; CBF ϭ cerebral blood flow; CI ϭ confidence interval; DWI ϭ diffusion-weighted imaging; ICH ϭ intracerebral hemorrhage; MR ϭ magnetic resonance; NIHSS ϭ National Institute of Health Stroke Scale; PWI ϭ perfusion-weighted imaging; tPA ϭ tissue plasminogen activator.

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confidence: 99%

Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke [RETIRED]

et al. 2010

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“…DW MRI is already an established method used routinely at several institutions in the diagnosis of acute stroke [5]. Until recently, only a few studies have involved measurement of water diffusion in the kidneys [11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…Diffusion-weighted (DW) MRI is an established method used in the diagnosis of acute stroke [5]. Diffusion-weighted imaging (DWI) provides quantification of Brownian motion of water protons by calculating the apparent diffusion coefficient (ADC), and can be used for in vivo quantification of the combined effects of capillary perfusion and diffusion [6].…”

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confidence: 99%

Role of diffusion-weighted MRI in diagnosis of acute renal allograft dysfunction: a prospective preliminary study

El-Ghar

El-Diasty²,

El‐Assmy³

et al. 2012

BJR

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Objective: The aim was to evaluate the effects of diagnostic performance of diffusionweighted (DW) MRI in the assessment of acute impairment of transplanted kidneys. Methods: From January 2009 to January 2010, 49 patients with stable renal allograft function (Group 1) and 21 patients with acute graft impairment (Group 2) were included in the study. All patients were evaluated with coronal T 2 weighted (T 2 W) and DW MRI of the kidney. Patients in Group 2 underwent graft biopsy to determine the underlying histopathological aetiology. Apparent diffusion coefficient (ADC) was calculated and the kidneys were studied for any areas of diffusion restriction. Two radiologists, who were blinded to the results of histopathology, independently interpreted the T 2 W and DW images. Results: The histopathological diagnosis ofGroup 2 (21 patients) was acute cellular rejection (ACR) in 10, acute tubular necrosis (ATN) in 7 and immunosuppressive toxicity in 4 patients. ADC values in Group 1 were significantly higher compared with Group 2 (p,0.001), patients with ACR (p,0.001), patients with ATN (p,0.001) and patients with drug toxicity (p,0.001). Using 2610 23 mm 2 s 21 as a cut-off, there was no overlap between the ADC values of patients with normal graft function and those with ATN. Both ACR and ATN had a low ADC value, but on the ADC map the kidney in cases of ATN appears heterogeneous with a characteristic mosaic pattern resembling the Tiger skin. There was no significant T 2 W morphological difference between the two groups. Conclusion: These results show how DW MRI is a promising new technique for the diagnosis of acute renal transplant dysfunction.

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“…Many centers have demonstrated that logistical obstacles can be overcome [56,57,58,59]. Despite this, substantial doubts remain regarding the feasibility and practicality as well as the validity of stroke MRI in the clinical setting [60, 61].…”

Section: Intravenous Thrombolysis Based On Advanced Mrimentioning

confidence: 99%

Acute Stroke Imaging for Thrombolytic Therapy – An Update

et al. 2007

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More than ten years after its approval intravenous thrombolysis with rtPA still is the only approved therapy for acute ischemic stroke. In this review we aim to give an up-to-date overview of acute stroke imaging within and outside of approved indications for thrombolysis. We discuss the potential applications of modern CT techniques such as CT angiography and perfusion CT as well as stroke MRI for the selection-based treatment of acute ischemic stroke. Recent publications regarding diagnostic strength as well as new randomized trials and larger prospective but open studies are reviewed and discussed. Finally we present a suggestion for the selection of patients for thrombolysis within and beyond the 3-hour time window in the form of an institutional algorithm prioritizing according to present evidence and pathophysiological reasoning.

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Audit of a Policy of Magnetic Resonance Imaging with Diffusion-weighted Imaging as First-line Neuroimaging for In-patients with Clinically Suspected Acute Stroke

Cited by 39 publications

References 13 publications

Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke [RETIRED]

Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke [RETIRED]

Role of diffusion-weighted MRI in diagnosis of acute renal allograft dysfunction: a prospective preliminary study

Acute Stroke Imaging for Thrombolytic Therapy – An Update

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