{"id":"8ba18513-33f2-4986-b9f6-b4f9e5db8040","slug":"sagittal-diffusion-weighted-imaging-in-preventing-the-false-negative-diagnosis-of-acute-brainstem-infarction-confirmation-of-the-benefit-by-anatomical-characterization-of-false-negative-lesions","title":"Sagittal diffusion-weighted imaging in preventing the false-negative diagnosis of acute brainstem infarction: Confirmation of the benefit by anatomical characterization of false-negative lesions","authors":["Nobuyuki Takeshige","Takachika Aoki","Kiyohiko Sakata","Soushou Kajiwara","Tetsuya Negoto","Satoshi Nagase","Syuichi Tanoue","Yusuke Uchiyama","Masaru Hirohata","Toshi Abe","Motohiro Morioka"],"abstract":"Background: In some cases of acute brainstem infarction (BI), standard axial diffusion-weighted imaging (DWI) does not show a lesion, leading to false-negative (FN) diagnoses. It is important to recognize acute BI accurately and promptly to initiate therapy as soon as possible. Methods: Of the 171 patients with acute cerebral infarctions in our institution who were examined, 16 were diagnosed with true-positive BI (TP-BI) and six with FN-BI. We evaluated the effectiveness of sagittal DWI in accurately diagnosing acute BI and sought to find the cause of its effectiveness by the anatomical characterization of FN-BIs. Results: Considering the direction of the brainstem perforating arteries, we supposed that sagittal DWI might more effectively detect BIs than axial DWI. We found that sagittal DWI detected all FN-BIs more clearly than axial DWI. The mean time between the onset of symptoms and initial DWI was significantly longer in the TP group (17.6 ± 5.5 h) than in the FN group (5.0 ± 1.2 h; P 3) than in TP-BIs (2779 ± 767 mm3; P = 0.0007). FN-BIs had a significant inverse correlation with the ventrodorsal length of infarcts (FN 3.5 ± 1.1 mm, TP 11.4 ± 3.6 mm; P < 0.0004) and no correlation with other size parameters such as rostrocaudal thickness and lateral width. Conclusion: Anatomical characterization clearly confirmed that the addition of sagittal DWI to the initial axial DWI in suspected cases of BI ensures its accurate diagnosis and improves the patient’s prognosis.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/8ba18513-33f2-4986-b9f6-b4f9e5db8040/featured/hero-1781563766711.png","publishDate":"2019-09-20T00:00:00.000Z","doi":"10.25259/SNI_182_2019","categories":["Neurovascular","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2019/09/9663/SNI-10-180.pdf"}