Diffusion-weighted magnetic resonance in the diagnosis of a cute subcortical infarcts

Introduction. The diagnostic efficacy of radiological studies in acute subcortical infarcts is limited by the low sensitivity of conventional computerized tomography (CT) and magnetic resonance (MR) in detecting small-sized infarcts, and the difficulty in differentiating acute from chronic lesions. Diffusion-weighted MR (DMR) has shown great sensitivity and specificity in the detection of small vessel ischemic lesions during the acute phase. Objective. To determine the diagnostic value of DMR in the study of patients with subcortical infarcts during the acute phase. Patients and methods. We made a prospective analysis of 100 consecutive patients with a clinical diagnosis of subcortical infarct. In all cases MR examination,vas done within the first 10 days (average 3.9 days) following onset, using conventional and diffusion-weighted sequences. Results. In all cases the DMR showed the presence of ischemic lesions which explained, at least partly, the clinical features of the stroke. In 42 patients (42%) the DMR gave relevant information for diagnosis, as compared with the conventional MR studies, by confirming the presence of an ischemic lesion responsible for the clinical picture. The percentage rose to 50% when the examination was done within the first two days. Conclusions. DMR gives useful information in a high percentage of patients with acute subcortical infarcts. This is due to its great sensitivity in the detection of acute lesions of small size, and capacity to distinguish acute from chronic lesions.