Original investigationDiffusion-weighted Imaging in Ischemic Stroke: Effect of Display Method on Observers' Diagnostic Performance
Section snippets
Selection of Patients and Controls
A total of 30 magnetic resonance imaging (MRI) studies on 30 patients who underwent MRI between January 2001 and July 2003 were collected from seven Japanese centers for this retrospective study of the effect of the DWI display method on the diagnosis of acute cerebral infarction. The inclusion criteria were acquisition of MRI scans within 6 hours of ischemic stroke onset; an age range of 40 to 85 years; the use of a 1.5-T MRI scanner featuring a head coil, echo-planar capability, and identical
Diagnostic Performance
With respect to the detection of a modified ASPECTS score of ≤8 points, we compared the mean Az values obtained with the CDM and the SDM (Table 1). In all observers, the mean Az value was slightly higher with the SDM than the CDM (0.979 ± 0.026 vs 0.971 ± 0.037); the difference was not statistically significant (P = .33) (Fig 4). There was no significant difference in the mean Az values obtained with the CDM and the SDM by readers grouped according to their specialties. On the other hand,
Discussion
The diagnostic accuracy of the insular ribbon was significantly increased when the images were displayed with the SDM. The highest number of false-positive assessments per case per session was recorded for the insular ribbon. On DWI, the brain cortices manifest physiologic regional signal variation; in healthy subjects, the insular and the cingulate cortices show higher SI than the other cerebral cortices (17). This phenomenon is probably due to T2 shine-through (18). In addition, DWI display
Acknowledgments
We are grateful to Shoji Morishita, Yoshiko Hayashida, Ichiro Ikushima, Yoshinori Shigematsu, Mika Kitajima, Tomoko Okuda, Masayuki Yamura, Koichi Kawanaka, Yoshiharu Nakayama, Masanori Imuta, Takanori Negishi, Shinichiro Kusunoki, Shinya Shiraishi, Masaki Watanabe, Tomoo Hirahara, Sadahisa Okamoto, Akihiko Ueda, Motohiro Morioka, Keishi Makino, Hideo Takeshima, and Shigetoshi Yano for participating in our observer performance study. We gratefully thank the investigators and collaborators of
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Departments of Diagnostic Radiology (T. Hirai, H.F., A.S., Y.Y.), Neurology (T. Hirano), Neurosurgery (Y.K.), and Radiation Oncology (R.M.), Graduate School of Medical Sciences, and Kumamoto University Hospital (R.I.), Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan; the Advanced Medical Research Center, Iwate Medical University, Uchimaru, Morioka, Japan (M. Sasaki); the Department of Radiology, Mie University School of Medicine, Tsu, Mie, Japan (M.M.); the Department of Radiology, Ebara Hospital, Tokyo, Japan (M.I.); the Department of Radiological Technology, Kumamoto University School of Health Sciences, Kumamoto, Japan (S. Katsuragawa); the Department of Rehabilitation, Hatsudai Rehabilitation Hospital, Tokyo, Japan (M. Sakoh); the Department of Radiology, Fukuoka University, School of Medicine, Fukuoka, Japan (K.T., S.A.); and the Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan (S. Kakeda). This work was partly supported by a Grant for Standardization Projects from the Japanese Society for Magnetic Resonance in Medicine and by a Research Grant for Cardiovascular Diseases (17C-3) from the Ministry of Heath, Labour, and Welfare of Japan