Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke
Background and PurposeDistinction between acute ischemic stroke (AIS) and status epilepticus (SE) on MRI can be challenging as restricted diffusion may occur in both conditions. In this study, we aimed to test a tool, which could help in differentiating AIS from SE when restricted diffusion was pres...
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.926381/full |
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| author | Lukas Machegger Pilar Bosque Varela Giorgi Kuchukhidze Giorgi Kuchukhidze Jürgen Steinbacher Andreas Öllerer Tanja Prüwasser Tanja Prüwasser Georg Zimmermann Georg Zimmermann Georg Zimmermann Slaven Pikija Johannes Pfaff Eugen Trinka Eugen Trinka Eugen Trinka Mark Mc Coy Mark Mc Coy |
| author_facet | Lukas Machegger Pilar Bosque Varela Giorgi Kuchukhidze Giorgi Kuchukhidze Jürgen Steinbacher Andreas Öllerer Tanja Prüwasser Tanja Prüwasser Georg Zimmermann Georg Zimmermann Georg Zimmermann Slaven Pikija Johannes Pfaff Eugen Trinka Eugen Trinka Eugen Trinka Mark Mc Coy Mark Mc Coy |
| author_sort | Lukas Machegger |
| collection | DOAJ |
| description | Background and PurposeDistinction between acute ischemic stroke (AIS) and status epilepticus (SE) on MRI can be challenging as restricted diffusion may occur in both conditions. In this study, we aimed to test a tool, which could help in differentiating AIS from SE when restricted diffusion was present on MRI.Materials and MethodsIn diffusion weighted imaging (DWI) with a b-value of 1,000 and apparent diffusion coefficient (ADC) maps, we compared the ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side in patients with AIS and SE. Patients were recruited prospectively between February 2019 and October 2021. All patients underwent MRI and EEG within the first 48 h of symptom onset.ResultsWe identified 26 patients with SE and 164 patients with AIS. All patients had diffusion-restricted lesions with a hyperintensity in DWI and ADC signal decrease. Diffusion restriction was significantly more intense in patients with AIS as compared to patients with SE. The median ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side for DWI were 1.42 (interquartile range [IQR] 1.32–1.47) in SE and 1.67 (IQR 1.49–1.90) in AIS (p < 0.001). ADC decrease was more significant in AIS as compared to SE with median ratios of 0.80 (IQR 0.72–0.89) vs. 0.61 (IQR 0.50–0.71), respectively (p < 0.001). A cutoff value for ratios of DWI signal was 1.495 with a sensitivity of 75% and a specificity of 85%. Values lower than 1.495 were more likely to be associated with SE and higher values were with AIS. A cutoff value for ADC ratios was 0.735 with a sensitivity of 73% and a specificity of 84%. Values lower than 0.735 were more likely to be associated with AIS and higher values were with SE.ConclusionDiffusion restriction and ADC decrease were significantly more intense in patients with AIS as compared to SE. Therefore, quantitative analysis of diffusion restriction may be a helpful tool for differentiating between AIS and SE when restricted diffusion is present on MRI. |
| first_indexed | 2024-12-11T03:27:50Z |
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| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-11T03:27:50Z |
| publishDate | 2022-07-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-85fd7f04fdfa4132a6778a5022ea7ca32022-12-22T01:22:27ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-07-011310.3389/fneur.2022.926381926381Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic StrokeLukas Machegger0Pilar Bosque Varela1Giorgi Kuchukhidze2Giorgi Kuchukhidze3Jürgen Steinbacher4Andreas Öllerer5Tanja Prüwasser6Tanja Prüwasser7Georg Zimmermann8Georg Zimmermann9Georg Zimmermann10Slaven Pikija11Johannes Pfaff12Eugen Trinka13Eugen Trinka14Eugen Trinka15Mark Mc Coy16Mark Mc Coy17Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, AustriaDepartment of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, AustriaDepartment of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, AustriaCentre for Cognitive Neuroscience Salzburg, Neuroscience Institute, Christian Doppler University Hospital, Salzburg, AustriaDepartment of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, AustriaDepartment of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, AustriaDepartment of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, AustriaDepartment of Mathematics, Paris-Lodron University, Salzburg, AustriaDepartment of Mathematics, Paris-Lodron University, Salzburg, AustriaIDA Lab Salzburg, Team Biostatistics and Big Medical Data, Paracelsus Medical University, Salzburg, AustriaResearch and Innovation Management, Paracelsus Medical University, Salzburg, AustriaDepartment of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, AustriaDepartment of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, AustriaDepartment of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, AustriaCentre for Cognitive Neuroscience Salzburg, Neuroscience Institute, Christian Doppler University Hospital, Salzburg, AustriaKarl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, AustriaDepartment of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, AustriaCentre for Cognitive Neuroscience Salzburg, Neuroscience Institute, Christian Doppler University Hospital, Salzburg, AustriaBackground and PurposeDistinction between acute ischemic stroke (AIS) and status epilepticus (SE) on MRI can be challenging as restricted diffusion may occur in both conditions. In this study, we aimed to test a tool, which could help in differentiating AIS from SE when restricted diffusion was present on MRI.Materials and MethodsIn diffusion weighted imaging (DWI) with a b-value of 1,000 and apparent diffusion coefficient (ADC) maps, we compared the ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side in patients with AIS and SE. Patients were recruited prospectively between February 2019 and October 2021. All patients underwent MRI and EEG within the first 48 h of symptom onset.ResultsWe identified 26 patients with SE and 164 patients with AIS. All patients had diffusion-restricted lesions with a hyperintensity in DWI and ADC signal decrease. Diffusion restriction was significantly more intense in patients with AIS as compared to patients with SE. The median ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side for DWI were 1.42 (interquartile range [IQR] 1.32–1.47) in SE and 1.67 (IQR 1.49–1.90) in AIS (p < 0.001). ADC decrease was more significant in AIS as compared to SE with median ratios of 0.80 (IQR 0.72–0.89) vs. 0.61 (IQR 0.50–0.71), respectively (p < 0.001). A cutoff value for ratios of DWI signal was 1.495 with a sensitivity of 75% and a specificity of 85%. Values lower than 1.495 were more likely to be associated with SE and higher values were with AIS. A cutoff value for ADC ratios was 0.735 with a sensitivity of 73% and a specificity of 84%. Values lower than 0.735 were more likely to be associated with AIS and higher values were with SE.ConclusionDiffusion restriction and ADC decrease were significantly more intense in patients with AIS as compared to SE. Therefore, quantitative analysis of diffusion restriction may be a helpful tool for differentiating between AIS and SE when restricted diffusion is present on MRI.https://www.frontiersin.org/articles/10.3389/fneur.2022.926381/fullstatus epilepticsdiffusion restrictionMRIacute ischemic strokequantification |
| spellingShingle | Lukas Machegger Pilar Bosque Varela Giorgi Kuchukhidze Giorgi Kuchukhidze Jürgen Steinbacher Andreas Öllerer Tanja Prüwasser Tanja Prüwasser Georg Zimmermann Georg Zimmermann Georg Zimmermann Slaven Pikija Johannes Pfaff Eugen Trinka Eugen Trinka Eugen Trinka Mark Mc Coy Mark Mc Coy Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke Frontiers in Neurology status epileptics diffusion restriction MRI acute ischemic stroke quantification |
| title | Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke |
| title_full | Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke |
| title_fullStr | Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke |
| title_full_unstemmed | Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke |
| title_short | Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke |
| title_sort | quantitative analysis of diffusion restricted lesions in a differential diagnosis of status epilepticus and acute ischemic stroke |
| topic | status epileptics diffusion restriction MRI acute ischemic stroke quantification |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.926381/full |
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