Department of Diagnostic and Interventional Radiology (P.S., L.-S.B., C.T., T.F., C.R.H.), Marienkrankenhaus Hamburg, Germany.
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.S., R.M., C.T., T.F., J.F., M.H.S.).
Stroke. 2021 May;52(5):1843-1846. doi: 10.1161/STROKEAHA.120.032457. Epub 2021 Apr 5.
To evaluate the benefit of a coronal diffusion-weighted imaging (DWI) in addition to standard axial DWI for the detection of brain stem infarctions.
A retrospective analysis of patients with symptoms consistent with acute and subacute brain stem infarction who received magnetic resonance imaging, including axial and coronal DWI. Diffusion restrictions were identified by 2 independent raters blinded for the final clinical diagnosis in 3 separate reading steps: axial DWI, coronal DWI, and combined axial and coronal DWI. Lesion location and certainty level were both documented for each reading step. In cases of reader disagreement, an additional consensus reading was performed.
Two hundred thirty-nine patients were included. Of these, 124 patients (51.9%) were clinically diagnosed with brain stem infarction. Sensitivity, specificity, positive, and negative predictive values were best for combined DWI assessment (90.3%, 99.1%, 99.1%, and 90.5%) compared with axial (85.5%, 94.9%, 94.6%, and 85.8%) and coronal DWI alone (87.9%, 96.5%, 96.5%, and 88.1%). Diffusion restriction on combined DWI was diagnosed in 112/124 patients compared with 106/124 on axial DWI and 109/124 on coronal DWI. Interobserver agreement for the detection of brain stem lesions was the highest in the combined rating step (Cohen κ coefficient=0.94).
Coronal DWI sequences might improve the detection rate of brain stem infarction compared with standard axial DWI. The combined coronal and axial DWI provides the best detection rate while minimally increasing scan times.
评估冠状扩散加权成像（DWI）对脑干梗死检测的附加价值。
对符合急性和亚急性脑干梗死症状并接受磁共振成像（包括轴位和冠状 DWI）的患者进行回顾性分析。2 位独立的评估者在 3 个独立的阅读步骤中，对最终临床诊断进行盲法评估，识别出轴向 DWI、冠状 DWI 和轴向加冠状 DWI 的扩散受限。记录了每个阅读步骤的病变位置和确定性水平。如果读者意见不一致，则进行额外的共识阅读。
共纳入 239 例患者，其中 124 例（51.9%）患者被临床诊断为脑干梗死。与轴位 DWI（85.5%、94.9%、94.6%和 85.8%）和单纯冠状 DWI（87.9%、96.5%、96.5%和 88.1%）相比，联合 DWI 评估的敏感性、特异性、阳性预测值和阴性预测值最高（90.3%、99.1%、99.1%和 90.5%）。与轴位 DWI（106/124）和冠状 DWI（109/124）相比，在联合 DWI 上诊断出扩散受限的患者有 112/124 例。在联合评分步骤中，检测脑干病变的观察者间一致性最高（Cohen κ 系数=0.94）。
与标准轴位 DWI 相比，冠状 DWI 序列可能提高脑干梗死的检出率。联合冠状和轴向 DWI 提供了最佳的检出率，同时最小化了扫描次数。
