Diffusion-weighted Imaging at b1000 for Identifying Intracerebral Hemorrhage: Preliminary Sensitivity, Specificity, and Inter-rater Variability

Background Noncontrast computed tomography (NCCT) is the gold standard to detect intracerebral hemorrhage (ICH) and ischemic stroke (IS) in patients presenting with acute focal syndromes. Diffusion-weighted magnetic resonance imaging (DW-MRI) obtained at b1000 is highly sensitive to identify acute I...

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Bibliographic Details
Published in:Journal of stroke and cerebrovascular diseases 2014-08, Vol.23 (7), p.1934-1938
Main Authors: Keigler, Galina, MD, Goldberg, Ilan, MD, Eichel, Roni, MD, Gomori, John M., MD, Cohen, Jose E., MD, Leker, Ronen R., MD, FAHA
Format: Article
Language:English
Subjects:
Aged
Brain Ischemia - diagnosis
Brain Ischemia - pathology
Cardiovascular
Cerebral Hemorrhage - diagnosis
Cerebral Hemorrhage - pathology
cerebrovascular disease
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging - methods
diffusion-weighted MRI
Female
Humans
intracerebral hemorrhage
Male
Middle Aged
Neurology
Observer Variation
Pilot Projects
Reproducibility of Results
Stroke
Stroke - diagnosis
Stroke - pathology
Tomography, X-Ray Computed
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Summary:Background Noncontrast computed tomography (NCCT) is the gold standard to detect intracerebral hemorrhage (ICH) and ischemic stroke (IS) in patients presenting with acute focal syndromes. Diffusion-weighted magnetic resonance imaging (DW-MRI) obtained at b1000 is highly sensitive to identify acute IS but its sensitivity and specificity to detect ICH has not been systematically studied. Methods Patients with a diagnosis of ICH on NCCT were prospectively enrolled and underwent DW-MRI at b1000. Patients with suspected ischemia and a negative NCCT served as controls. All diffusion-weighted imaging (DWI) scans were evaluated blindly by 4 experienced raters. Sensitivity, specificity, and inter-rater variability of the DWI b1000 scans for detection of ICH were determined. Results In this preliminary pilot study, 15 patients with ICH and 17 patients with IS were included. All ICH lesions seen on NCCT showed a typical pattern on DW-MRI at b1000 with a hypointense core surrounded by a hyperintense rim. ICH volumes and size were similar on NCCT and MRI. All cases of IS were identified on the DWI scans but none were apparent on NCCT. The mean sensitivity and specificity of DW-MRI at b1000 for ICH were 94% and 93.5%, respectively, and the inter-rater variability for ICH detection on DWI was excellent (κ = .84). Conclusions DW-MRI at b1000 has a diagnostic yield similar to NCCT for detecting ICH and superior to NCCT for detecting IS. Therefore, DW-MRI may be considered as the initial screening tool for imaging patients presenting with focal neurologic symptoms suggestive of stroke.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2014.02.005