Early DWI reversal in ischemic stroke
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At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosuresAt the time the article was last revised Patrick J Rock had no recorded disclosures.
View Patrick J Rock's current disclosures- Diffusion lesion reversal
- Early diffusion lesion reversal
- Early diffusion reversal in ischaemic stroke
Early DWI reversal in ischemic stroke (also referred to as diffusion lesion reversal) is encountered early in the course of ischemic infarction, most frequently in the setting of reperfusion within 3 to 6 hours of onset 1.
DWI reversal is defined as the interval disappearance of the initially-visible increased DWI signal on repeat MRI scan. In the vast majority of cases it is transient and the abnormal DWI signal returns. That is, it does not represent true reversal (i.e. the region of the brain initially demonstrating reduced ADC values goes on to infarct regardless of whether early DWI reversal is demonstrated) 1,2.
It should be noted that in other clinical contexts (e.g. hemiplegic migraine, seizure, transient ischemic attack and transient global amnesia) permanent diffusion lesion reversal, without progression to permanent lesion has been rarely encountered 3.
Note: Early DWI reversal should not be confused with ADC pseudonormalization which occurs later in the evolution of ischemic stroke.
Quiz questions
References
- 1. Inoue M, Mlynash M, Christensen S et-al. Early diffusion-weighted imaging reversal after endovascular reperfusion is typically transient in patients imaged 3 to 6 hours after onset. Stroke. 2014;45 (4): 1024-8. doi:10.1161/STROKEAHA.113.002135 - Free text at pubmed - Pubmed citation
- 2. Campbell BC, Purushotham A, Christensen S et-al. The infarct core is well represented by the acute diffusion lesion: sustained reversal is infrequent. J. Cereb. Blood Flow Metab.32 (1): 50-6. doi:doi:10.1038/jcbfm.2011.102 - Free text at pubmed - Pubmed citation
- 3. Grant PE, He J, Halpern EF et-al. Frequency and clinical context of decreased apparent diffusion coefficient reversal in the human brain. Radiology. 2001;221 (1): 43-50. doi:10.1148/radiol.2211001523 - Pubmed citation
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