Value of combination of standard axial and thin-section coronal diffusion-weighted imaging in diagnosis of acute brainstem infarction

Abstract

AIM: To determine the value of the combination of thin-section 3 mm coronal and standard axial DWl and their impact in facilitating the diagnosis of acute brainstem infarction. METHODS: A cross-sectional study conducted from the 1st of April 2017 to the end of February 2018 on 100 consecutive patients (66% were male, and 34% were female) with isolated acute ischemic infarction in the brainstem. The abnormal MRl findings concerning the ischemic lesions were interpreted on standard axial 5 mm and thin-section coronal 3mm DWl. RESULTS: The mean age of the studied group was 69.2 ± 4.3 for male and 72.3 ± 2.5 years. The standard axial DWl can diagnose 20%, 6.7% and 6.7% of the infarctions in midbrain, pons and medulla oblongata respectively, while both axial and thin coronal sections together can diagnose 80% of midbrain infarctions, 93.3% of pons infarctions and 93.3% of medulla oblongata infarctions. Furthermore, the thin section coronal 3 mm section can diagnose very smaller ischemic lesion volume in comparison to the standard axial 5mm section (3.4 ± 0.45 / cm3 versus 4.6 ± 0.23 / cm3, P < 0.001) CONCLUSION: The addition of thin-section coronal DWl can facilitate the detection of brainstem ischemic lesions. We suggest its inclusion in the stroke MRl protocol.