We use current DWIs from pts on our stroke unit to discuss the unterpretation of DWI. We also aim to mention the physics of diffusion imaging in general, including DTI and DSI, perhaps with some fiber tracking.
- For the physics part, we use the following article: http://radiographics.rsna.org/content/26/suppl_1/S205.full.pdf
- Some animations on this page can help explaining.
- This recent article in stroke clarifies which part of the DWI lesion actually will become stroke core, using PWI-MTT
Here is the differential for DWI bright lesions:
- Stroke (ADC low, DWI high, T2 high if > 2-3h; ADC/DWI normalizes in 10-14d, might become bright than with elevated ADC)
- The core of edematous lesions (venous thrombosis, PRES, …): ADC decreased in some areas, mostly high
- T2 shine through (ADC high, DWI high, T2 high): old lesion
- Tumors with central necrosis or low cytoplasma/nuclear ratio
- Metbolic lesions (Wernicke, CPM, Leukodystrophies)
- Proteinaceous fluid (aka pus) or subacute blood
- Acute demyelination