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NEUROLOGY 1992;42:1717
© 1992 American Academy of Neurology

Fast magnetic resonance diffusion-weighted imaging of acute human stroke

S. Warach, MD, PhD, D. Chien, PhD, W. Li, MD, M. Ronthal, MB, BCh and R. R. Edelman, MD

Harvard-Longwood Neurology Training Program and Departments of Neurology, Harvard Medical School, Beth Israel Hospital, Boston, MA (Dr. Warach and M. Ronthal)
Departments of Radiology, Harvard Medical School, Beth Israel Hospital, Boston, MA (Drs. Warach, Chien, Li, and Edelman).

Rapid MRI of the molecular diffusion of water demonstrated cerebral infarcts in 32 patients. We studied these patients at various times following the onset of ischemic symptoms and found that diffusion-weighted imaging revealed the infarcts sooner than conventional T2-weighted spin-echo imaging did; four hyperacute infarcts were shown only by diffusion-weighted imaging. Acute infarcts had lower apparent diffusion coefficients (ADCs) than noninfarcted regions did. This relative difference in ADC reached a nadir in the first 24 hours and rose progressively thereafter. Chronic infarcts showed a relative increase in diffusion and were readily distinguishable from acute infarcts. The technique takes less than 2 minutes to apply using a standard 1.5-tesla scanner in the clinical setting. Diffusion-weighted imaging has the potential to play a role in improving the early anatomic diagnosis of stroke and therefore in the development and implementation of early stroke interventions.

Received January 10, 1992. Accepted for publication in final form February 14, 1992.

Address correspondence and reprint requests to Dr. Steven Warach, Department of Neurology, Harvard Medical School, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.




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M. C. DeLano, T. G. Cooper, J. E. Siebert, M. J. Potchen, and K. Kuppusamy
High-b-value Diffusion-weighted MR Imaging of Adult Brain: Image Contrast and Apparent Diffusion Coefficient Map Features
AJNR Am. J. Neuroradiol., November 1, 2000; 21(10): 1830 - 1836.
[Abstract] [Full Text] [PDF]

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P. W. Schaefer, P. E. Grant, and R. G. Gonzalez
Diffusion-weighted MR Imaging of the Brain
Radiology, November 1, 2000; 217(2): 331 - 345.
[Abstract] [Full Text]

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S. L. Keir and J. M. Wardlaw
Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke
Stroke, November 1, 2000; 31(11): 2723 - 2731.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
M. Augustin, R. Bammer, J. Simbrunner, R. Stollberger, H.-P. Hartung, and F. Fazekas
Diffusion-weighted Imaging of Patients with Subacute Cerebral Ischemia: Comparison with Conventional and Contrast-enhanced MR Imaging
AJNR Am. J. Neuroradiol., October 1, 2000; 21(9): 1596 - 1602.
[Abstract] [Full Text]

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D. G. Darby, M. W. Parsons, P. A. Barber, S. M. Davis, J.-K. Roh, and D.-W. Kang
Significance of Acute Multiple Brain Infarction on Diffusion-Weighted Imaging Response
Stroke, September 1, 2000; 31 (9): 2266 - 2278.
[Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
K. P. N. Forbes, J. G. Pipe, and R. Bird
Neonatal Hypoxic-ischemic Encephalopathy: Detection with Diffusion-weighted MR Imaging
AJNR Am. J. Neuroradiol., August 1, 2000; 21(8): 1490 - 1496.
[Abstract] [Full Text]

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A. Barth, L. Remonda, K.-O. Lovblad, G. Schroth, and R. W. Seiler
Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy
Stroke, August 1, 2000; 31(8): 1824 - 1828.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
P. D Schellinger, O. Jansen, J. B Fiebach, O. Pohlers, H. Ryssel, S. Heiland, T. Steiner, W. Hacke and, and K. Sartor
Feasibility and Practicality of MR Imaging of Stroke in the Management of Hyperacute Cerebral Ischemia
AJNR Am. J. Neuroradiol., July 1, 2000; 21(7): 1184 - 1189.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
S. W. Atlas, P. DuBois, M. B. Singer, and D. Lu
Diffusion Measurements in Intracranial Hematomas: Implications for MR Imaging of Acute Stroke
AJNR Am. J. Neuroradiol., July 1, 2000; 21(7): 1190 - 1194.
[Abstract] [Full Text] [PDF]

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 Arch NeurolHome page
M. Filippi, G. Iannucci, M. Cercignani, M. Assunta Rocca, A. Pratesi, and G. Comi
A Quantitative Study of Water Diffusion in Multiple Sclerosis Lesions and Normal-Appearing White Matter Using Echo-Planar Imaging
Arch Neurol, July 1, 2000; 57(7): 1017 - 1021.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
S. Roychowdhury, J. A. Maldjian, and R. I. Grossman
Multiple Sclerosis: Comparison of Trace Apparent Diffusion Coefficients with MR Enhancement Pattern of Lesions
AJNR Am. J. Neuroradiol., May 1, 2000; 21(5): 869 - 874.
[Abstract] [Full Text]

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C. J. Chaves, B. Silver, G. Schlaug, J. Dashe, L. R. Caplan, and S. Warach
Diffusion- and Perfusion-Weighted MRI Patterns in Borderzone Infarcts
Stroke, May 1, 2000; 31(5): 1090 - 1096.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
M. G. Lansberg, G. W. Albers, C. Beaulieu, and M. P. Marks
Comparison of diffusion-weighted MRI and CT in acute stroke
Neurology, April 25, 2000; 54(8): 1557 - 1561.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
P. Mukherjee, M. M. Bahn, R. C. McKinstry, J. S. Shimony, T. S. Cull, E. Akbudak, A. Z. Snyder, and T. E. Conturo
Differences between Gray Matter and White Matter Water Diffusion in Stroke: Diffusion-Tensor MR Imaging in 12 Patients
Radiology, April 1, 2000; 215(1): 211 - 220.
[Abstract] [Full Text]

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M. Cercignani, G. Iannucci, M. A. Rocca, G. Comi, M. A. Horsfield, and M. Filippi
Pathologic damage in MS assessed by diffusion-weighted and magnetization transfer MRI
Neurology, March 14, 2000; 54(5): 1139 - 1144.
[Abstract] [Full Text] [PDF]

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R. Pineiro, S. T. Pendlebury, S. Smith, D. Flitney, A. M. Blamire, P. Styles, and P. M. Matthews
Relating MRI Changes to Motor Deficit After Ischemic Stroke by Segmentation of Functional Motor Pathways
Stroke, March 1, 2000; 31(3): 672 - 679.
[Abstract] [Full Text] [PDF]

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J. R. Carhuapoma, P. Y. Wang, N. J. Beauchamp, P. M. Keyl, D. F. Hanley, and P. B. Barker
Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage
Stroke, March 1, 2000; 31(3): 726 - 732.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
M. Castillo, S. K. Mukherji, D. Isaacs, and J. K. Smith
Cerebral Infarctions: Evaluation with Single-Axis Versus Trace Diffusion-Weighted MR Imaging
Am. J. Roentgenol., March 1, 2000; 174(3): 853 - 857.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
A. E. Baird, K. O. Lovblad, G. Schlaug, R. R. Edelman, and S. Warach
Multiple acute stroke syndrome: Marker of embolic disease?
Neurology, February 8, 2000; 54(3): 674 - 674.
[Abstract] [Full Text] [PDF]

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K.-O. Lovblad and C. Basssetti
Diffusion-Weighted Magnetic Resonance Imaging in Brain Death
Stroke, February 1, 2000; 31(2): 539 - 542.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
S. H. Choi, D. L. Na, C. S. Chung, K. H. Lee, D. G. Na, and J. C. Adair
Diffusion-weighted MRI in vascular dementia
Neurology, January 11, 2000; 54(1): 83 - 83.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
J. R. Reichenbach, J. Röther, L. Jonetz-Mentzel, M. Herzau, A. Fiala, C. Weiller, and W. A. Kaiser
Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies
AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1842 - 1850.
[Abstract] [Full Text]

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Q. Yang, B. M. Tress, P. A. Barber, P. M. Desmond, D. G. Darby, R. P. Gerraty, T. Li, and S. M. Davis
Serial Study of Apparent Diffusion Coefficient and Anisotropy in Patients With Acute Stroke
Stroke, November 1, 1999; 30(11): 2382 - 2390.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
G. Schlaug, A. Benfield, A. E. Baird, B. Siewert, K. O. Lovblad, R. A. Parker, R. R. Edelman, and S. Warach
The ischemic penumbra: Operationally defined by diffusion and perfusion MRI
Neurology, October 22, 1999; 53(7): 1528 - 1528.
[Abstract] [Full Text] [PDF]

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P. A. Barber, D. G. Darby, P. M. Desmond, R. P. Gerraty, Q. Yang, T. Li, D. Jolley, G. A. Donnan, B. M. Tress, and S. M. Davis
Identification of Major Ischemic Change : Diffusion-Weighted Imaging Versus Computed Tomography
Stroke, October 1, 1999; 30(10): 2059 - 2065.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
M. Adachi, T. Hosoya, T. Haku, K. Yamaguchi, and T. Kawanami
Evaluation of the Substantia Nigra in Patients with Parkinsonian Syndrome Accomplished Using MultishotDiffusion-Weighted MR Imaging
AJNR Am. J. Neuroradiol., September 1, 1999; 20(8): 1500 - 1506.
[Abstract] [Full Text]

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 Am. J. Neuroradiol.Home page
P. E. Ricci, J. H. Burdette, A. D. Elster, and D. M. Reboussin
A Comparison of Fast Spin-Echo, Fluid-Attenuated Inversion-Recovery, and Diffusion-Weighted MR Imaging in the First 10 Days after Cerebral Infarction
AJNR Am. J. Neuroradiol., September 1, 1999; 20(8): 1535 - 1542.
[Abstract] [Full Text]

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 NeurologyHome page
C. M. Ellis, A. Simmons, D. K. Jones, J. Bland, J. M. Dawson, M. A. Horsfield, S. C. R. Williams, and P. N. Leigh
Diffusion tensor MRI assesses corticospinal tract damage in ALS
Neurology, September 1, 1999; 53(5): 1051 - 1051.
[Abstract] [Full Text] [PDF]

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A. G. Sorensen, O. Wu, W. A. Copen, T. L. Davis, R. G. Gonzalez, W. J. Koroshetz, T. G. Reese, B. R. Rosen, V. J. Wedeen, and R. M. Weisskoff
Human Acute Cerebral Ischemia: Detection of Changes in Water Diffusion Anisotropy by Using MR Imaging
Radiology, September 1, 1999; 212(3): 785 - 792.
[Abstract] [Full Text]

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 Am. J. Neuroradiol.Home page
B. Desprechins, T. Stadnik, G. Koerts, W. Shabana, C. Breucq, and M. Osteaux
Use of Diffusion-Weighted MR Imaging in Differential Diagnosis Between Intracerebral Necrotic Tumors and Cerebral Abscesses
AJNR Am. J. Neuroradiol., August 1, 1999; 20(7): 1252 - 1257.
[Abstract] [Full Text]

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J. L. Sunshine, R. W. Tarr, C. F. Lanzieri, D. M. D. Landis, W. R. Selman, and J. S. Lewin
Hyperacute Stroke: Ultrafast MR Imaging to Triage Patients prior to Therapy
Radiology, August 1, 1999; 212(2): 325 - 332.
[Abstract] [Full Text]

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 RadiologyHome page
J. H. Burdette, A. D. Elster, and P. E. Ricci
Acute Cerebral Infarction: Quantification of Spin-Density and T2 Shine-through Phenomena on Diffusion-weighted MR Images
Radiology, August 1, 1999; 212(2): 333 - 339.
[Abstract] [Full Text]

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 NeurologyHome page
J. W. Prichard and R. I. Grossman
New reasons for early use of MRI in stroke
Neurology, June 1, 1999; 52(9): 1733 - 1733.
[Full Text]


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