Even using diffusion-weighted images (DWI) detection of acute brainstem infarction (BI) is still a challenge. To evaluate the clinical efficacy of a DWI protocol with improved spatial resolution all images of 44 patients with clinically possible BI on admission (24 patients with definite BI and 20 patients with other etiologies) and first DWI within 24 h after symptom onset were blindly reanalyzed for visibility and detection of BI on the first DWI by reviewers with different expertise levels. Neuroradiologists identified definite BI in 21 out of 24 patients (sensitivity 90%, specificity 100%); neurologists and junior house officers achieved similar results (sensitivity 86 and 83%, specificity 98 and 97%). The use of DWI allows a definite diagnosis of BI, even if raters have limited experience.

1.
Albers GW: Diffusion-weighted MRI for evaluation of acute stroke. Neurology 1998;51:S47–S49.
2.
Schellinger PD, Fiebach JB, Jansen O, Ringleb PA, Mohr A, Steiner T, Heiland S, Schwab S, Pohlers O, Ryssel H, Orakcioglu B, Sartor K, Hacke W: Stroke magnetic resonance imaging within 6 hours after onset of hyperacute cerebral ischemia. Ann Neurol 2001;49:460–469.
3.
Sunshine JL, Tarr RW, Lanzieri CF, Landis DM, Selman WR, Lewin JS: Hyperacute stroke: Ultrafast MR imaging to triage patients prior to therapy. Radiology 1999;212:325–332.
4.
Yoneda Y, Tokui K, Hanihara T, Kitagaki H, Tabuchi M, Mori E: Diffusion-weighted magnetic resonance imaging: Detection of ischemic injury 39 minutes after onset in a stroke patient. Ann Neurol 1999;45:794–797.
5.
Schonewille WJ, Tuhrim S, Singer MB, Atlas SW: Diffusion-weighted MRI in acute lacunar syndromes. A clinical-radiological correlation study. Stroke 1999;30:2066–2069.
6.
Gerraty RP, Parsons MW, Barber PA, Darby DG, Desmond PM, Tress BM, Davis SM: Examining the lacunar hypothesis with diffusion and perfusion magnetic resonance imaging. Stroke 2002;33:2019–2024.
7.
Fitzek S, Fitzek C, Urban PP, Marx J, Hopf HC, Stoeter P: Time course of lesion development in patients with acute brain stem infarction and correlation with NIHSS score. Eur J Radiol 2001;39:180–185.
8.
Linfante I, Llinas RH, Schlaug G, Chaves C, Warach S, Caplan LR: Diffusion-weighted imaging and National Institutes of Health Stroke Scale in the acute phase of posterior-circulation stroke. Arch Neurol 2001;58:621–628.
9.
Toi H, Uno M, Harada M, Yoneda K, Morita N, Matsubara S, Satoh K, Nagahiro S: Diagnosis of acute brain-stem infarcts using diffusion-weighted MRI. Neuroradiology 2003;45:352–356.
10.
Engelter ST, Wetzel SG, Radue EW, Rausch M, Steck AJ, Lyrer PA: The clinical significance of diffusion-weighted MR imaging in infratentorial strokes. Neurology 2004;62:574–580.
11.
Kuker W, Weise J, Krapf H, Schmidt F, Friese S, Bahr M: MRI characteristics of acute and subacute brainstem and thalamic infarctions: Value of T2- and diffusion-weighted sequences. J Neurol 2002;249:33–42.
12.
Ay H, Buonanno FS, Rordorf G, Schaefer PW, Schwamm LH, Wu O, Gonzalez RG, Yamada K, Sorensen GA, Koroshetz WJ: Normal diffusion-weighted MRI during stroke-like deficits. Neurology 1999;52:1784–1792.
13.
Oppenheim C, Stanescu R, Dormont D, Crozier S, Marro B, Samson Y, Rancurel G, Marsault C: False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 2000;21:1434–1440.
14.
Narisawa A, Shamoto H, Shimizu H, Tominaga T, Yoshimoto T: Diffusion-weighted magnetic resonance imaging (MRI) in acute brain stem infarction. No To Shinkei 2001;53:1021–1026.
15.
Lovblad KO, Laubach HJ, Baird AE, Curtin F, Schlaug G, Edelman RR, Warach S: Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol 1998;19:1061–1066.
16.
World Health Organization: Proposal for the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA Project). Geneva, World Health Organization, 1983, MNC/82.1 Rev 1.
17.
Bogousslavsky J, Caplan L: Stroke Syndromes. Cambridge, Cambridge University Press, 2001, pp 371–404.
18.
Caplan LR: Vertebrobasilar Territory Ischemia: An Overview. Posterior Circulation Disease: Clinical Findings, Diagnosis and Management. Cambridge, Blackwell Science Ltd, 1996, pp 179–197.
19.
Fiebach JB, Schellinger PD, Jansen O, Meyer M, Wilde P, Bender J, Schramm P, Juttler E, Oehler J, Hartmann M, Hahnel S, Knauth M, Hacke W, Sartor K: 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 2002;33:2206–2210.
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