Role of Diffusion Weighted Imaging in Enhancing MR Imaging in Recent Is-chemic Stroke Patients


  • Hajer A. Alfadeel Department of Diagnostic Radiology, Faculty of Medicine, Omer Almukhtar University, Elbeida, Libya.



Diffusion Weighted Imaging, Conventional MRI, Weighted, FLAIR, Stroke


Stroke is a common cause of admission to hospitals, and imaging in acute stroke is necessary to differentiate ischemic from haemorrhagic stroke and to exclude other diagnoses. This study aimed to evaluate the role of diffusion-weighted magnetic resonance imaging (DW MRI) in the diagnosis of recent cerebral ischemic infarction in a consecutive series of patients with symptoms of acute stroke and its feasibility as first-line imaging for those patients. We report our results with DWI and apparent diffusion coefficient (ADC) mapping comparing the sensitivity of DWI with that of conventional T2 weighted and fluid-attenuated inversion recovery (FLAIR) MRI. A Prospective audit of 87 patients with clinically suspected recent stroke referred for imaging over a consecutive 20-week period was done. The data collected included patient age, time from onset of symptoms, and clinical presentation. DWI echo planar, FLAIR, and turbo spin-echo T2-weighted MRI were performed, and ADC maps were generated. Conventional MR images were assessed before DW images. DWI was considered positive for the diagnosis of new arterial stroke whenever hyperintensities with reduced ADC values were observed, and the site of infarct detected on the images was included in patients’ data. The results were 47 patients had a final diagnosis of recent ischemic cerebral infarct. With DWI, 98% of the ischemic lesions were detected, whereas with FLAIR, only 70% were detected, and with T2-weighted images, 66% of lesions were found. There was a significant difference between the results of ischemic infarcts’ detection on DWI and T2-w/FLAIR in relation to time from onset (P value = .012). In this study, I was able to image 68% (60 of 87) of the referred suspected stroke patients with DW MRI within 48 hours and 39 patients (45%) within 24 hours of the onset of symptoms. DW MRI showed high sensitivity and superiority over conventional T2 and FLAIR imaging for the detection of acute ischemic lesions in stroke patients; it also proved quite feasible as a first-line of neuroimaging.



Download data is not yet available.


Metrics Loading ...


Allen, L. M., Hasso, A. N., Handwerker, J., & Farid, H. (2012). Sequence-specific MR Imaging Findings That Are Useful in Dating Ischemic Stroke. RadioGraphics, 32(5), 1285-1297. DOI:

Augustin, M., Bammer, R., Simbrunner, J., Stollberger, R., Hartung, H. P., & Faze-kas, F. (2000). Diffusion-weighted im-aging of patients with subacute cerebral ischemia: comparison with conventional and contrast-enhanced MR imaging. American Journal of Neuroradiology, 21(9), 1596-1602. Retrieved from

Chalela, J. A., Kidwell, C. S., Nentwich, L. M., Luby, M., Butman, J. A., Demchuk, A. M., . . . Warach, S. (2007). Magnetic resonance imaging and computed to-mography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet (Lon-don, England), 369(9558), 293–298. DOI:

Choi, S. H., Na, D. L., Chung, C. S., Lee, K. H., Na, D. G., Adair, J. C. (2000). Dif-fusion-weighted MRI in vascular de-mentia, Neurology, 54(1), 83-89. DOI:

Fiebach, J. B., Schellinger, P. D., Jansen, O., Meyer, M., Wilde, P., Bender, J., . . . Sartor, K. (2002). CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke, 33(9), 2206–2210. DOI:

Gonzalez, R. G., Schaefer, P. W., Buonanno, F. S., Schwamm, L. H., Budzik, R. F., Rordorf, G., . . . Koroshetz, W. J. (1999). Diffusion-weighted MR imag-ing: diagnostic accuracy in patients im-aged within 6 hours of stroke symptom onset. Radiology, 210(1), 155–62. DOI:

Huisa, B. N., Liebeskind, D. S., Raman, R., Hao, Q., Meyer, B. C., Meyer, D. M., … University of California, Los Angeles Stroke Investigators (2013). Diffusion-weighted imaging-fluid attenuated inversion recovery mismatch in nocturnal stroke patients with unknown time of onset. J Stroke Cerebrovasc Dis, 22(7), 972–977. DOI:

Jauch, E. C., Saver, J. L., AdamsJr, H. P., Bruno, A., Connors, J. J., Demaerschalk, B. M., . . . Yonas, H. (2013). Guidelines for the Early Man-agement of Patients With Acute Is-chemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 44(3), 870–947. DOI:

Lansberg, M. G., Norbash, A. M., Marks M. P., Tong D. C., Moseley, M. E., & Albers, G. W. (2000). Advantages of Adding Diffusion-Weighted Magnetic Reso-nance Imaging to Conventional Magnetic Resonance Imaging for Evaluating Acute Stroke. Archives of neurology, 57(9), 1311–1316. DOI:

Lansberg, M. G., Thijs V. N., O'Brien, M. W., Ali, J. O., de Crespigny, A. J., Tong D. C., . . . Albers, G. W. (2001). Evolution of Apparent Diffusion Coefficient, Dif-fusion-weighted, and T2-weighted Signal Intensity of Acute Stroke. American Journal of Neuroradiology, 22(4), 637-644. Retrieved from

Leiva-Salinas, C., & Wintermark, M. (2010). Imaging of acute ischemic stroke. Neu-roimaging clinics of North America, 20(4), 455–468. DOI:

Maas, L. C., & Mukherjee, P. (2005). Diffusion MRI: Overview and clinical applications in neuroradiology. Applied Radiology. Retrieved from

Oppenheim, C., Stanescu, R., Dormont, D., Crozier, S., Marro, B., Samson, Y., . . . Marsault, C. (2000). False-negative dif-fusion-weighted MR findings in acute ischemic stroke. American Journal of Neuroradiology, 21(8), 1434–1440. Re-trieved from

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., . . . Tirschwell, D. L. (2019). Guidelines for the Early Man-agement of Patients With Acute Is-chemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 50(12), 344–418. DOI:

Rivers, C. S., Wardlaw, J. M., Armitage, P. A., Bastin, M. E., Carpenter, T. K., Cvoro, V., . . . Dennis, M. S. (2006). Persistent Infarct Hyperintensity on Diffusion-Weighted Imaging Late After Stroke Indicates Heterogeneous, Delayed, In-farct Evolution. Stroke, 37(6), 1418–1423. DOI:

Tan, P. L., King, D., Durkin, C. J., Meagher, T. M., & Briley, D. (2006). Diffusion weighted magnetic resonance imaging for acute stroke: practical and popu-lar. Postgraduate medical jour-nal, 82(966), 289–292. DOI:

Tsiouris, A. J., Qian, J. (2017). Advanced Im-aging in Acute Ischemic Stroke. Re-trieved from

Van Everdingen, K. J., van der Grond, J., Kap-pelle, L. J., Ramos, L. M. P., & Mali W. P. T. M. (1998). Diffusion-Weighted Magnetic Resonance Imaging in Acute Stroke. Stroke, 29(9), 1783–1790. DOI:




How to Cite

Alfadeel, H. A. (2020). Role of Diffusion Weighted Imaging in Enhancing MR Imaging in Recent Is-chemic Stroke Patients. Al-Mukhtar Journal of Sciences, 35(2), 104–115.



Research Articles


Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.