Potential of fluid-attenuated inversion recovery diffusion-weighted imaging in patients with acute cerebral infarction

Although the utility of magnetic resonance imaging (MRI) in the diagnosis and treatment planning of acute cerebral infarction is well established, MRI acquisition times are longer than those for computed tomography, suggesting the need for improved MRI imaging efficiency. Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR), integral to stroke protocols, are crucial for estimating the onset time of cerebral infarction. FLAIR DWI (F-DWI), which incorporates a long TI inversion recovery pulse into DWI, allows for the simultaneous acquisition of DWI and b0 FLAIR, significantly reducing imaging time. However, the impact of a long TI IR pulse on DWI remains unclear. Therefore, this study evaluated the utility of F-DWI and assessed its potential for reducing imaging time in patients with acute cerebral infarction. Qualitative image quality assessments (noise, distortion, artifacts, and overall image quality) of conventional DWI (C-DWI) and F-DWI were independently performed by two radiologists. Visual assessments included the presence of cerebral infarction, DWI/FLAIR mismatch, intraarterial sign, and FLAIR artifacts. The qualitative assessments were comparable between C-DWI and F-DWI. On visual assessment, F-DWI successfully detected acute cerebral infarction, indicating its potential diagnostic value. Furthermore, b0 FLAIR allowed the assessment of intraarterial sign and DWI/FLAIR mismatch, potentially obviating the need for c-FLAIR. Thus, F-DWI may contribute to shortening the time to treatment initiation for acute cerebral infarction.

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