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      Comparison of Diagnostic Effects of T2-Weighted Imaging, DWI, SWI, and DTI in Acute Cerebral Infarction

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            Abstract

            Objective: To achieve precision medicine, the use of imaging methods to help the clinical detection of cerebral infarction is conducive to the clinical development of a treatment plan and increase of the cure rate and improvement of the prognosis of patients.

            Methods: In this work, T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and diffusion tensor imaging (DTI) examinations were performed on 34 patients with clinically diagnosed cerebral infarction to measure the difference in signal intensity between the lesion and its mirror area and make a comparative analysis by means of the Student-Newman-Keuls method.

            Results: The detection rate of T2WI was 79% (27/34), the detection rate of DWI was 97% (33/34), the detection rate of SWI was 88% (30/34), and the detection rate of DTI was 94% (32/34).

            Conclusion: The imaging performance was in the order DWI > DTI > SWI > T2WI for the diagnosis of cerebral infarction, and combined imaging is better than single imaging.

            Main article text

            Introduction

            Ischemic cerebral infarction is harmful to human health and quality of life and causes great pain to humans [1]. To realize effective treatment of cerebral infarction, ensure the safety of patients with cerebral infarction, and determine the prognosis, accurate diagnosis of cerebral infarction has irreplaceable value in clinical practice.

            It is important to choose the best examination method for accurate diagnosis of cerebral infarction to realize effective treatment. In this work, 34 patients with cerebral infarction were examined by T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and diffusion tensor imaging (DTI) to measure the difference in signal intensity between the lesion and its mirror area and compare the four kinds of technologies for cerebral infarction diagnosis to help clinicians choose the best method to achieve a precise medical examination.

            The advantages of these imaging sequences are as follows. T2WI is often obtained with a fast spin echo to enhance the effect of the T2 value on image contrast and to highlight signals from tissues with higher T2 values such as fluids. SWI can collect intensity data and phase data, and can superimpose the processed phase information on intensity information. It is sensitive to paramagnetic components and has advantages in imaging cerebral vascular diseases. Weighted contrasts resulting from differences in voxel dispersion coefficients caused by the dispersion effect of the magnetic resonance signal (the dispersion movement of the spin nucleus correspondingly generates additional phase shifts) are used in DWI, and DWI has significant advantages in the diagnosis of cerebral infarction. DTI is an imaging method that uses the anisotropy of water dispersion to detect the microstructure of tissue. Using a variety of parameters and data processing, DTI can reflect the change of diffusion in imaging voxels quantitatively and directionally.

            Methods

            Under the condition of keeping other variables consistent and appropriate, T2WI, DWI, SWI, and DTI examinations were performed on 34 patients with clinically diagnosed cerebral infarction with use of a 3.0 T Signa Pioneer 2.0 MRI machine, and the differences in the signal intensity of the focal area and the specific signal value of the mirror area for each imaging technique were compared. The Student-Newman-Keuls method was used to compare the signal intensity statistics in pairs. An MRI technician with more than 10 years of clinical experience performed the entire procedure independently. All image data measurements for patients were completed by one person.

            Results

            By the Student-Newman-Keuls method, when DWI was compared with T2WI, the q value was 6.2614711, P = 0.0001, and the difference was statistically significant. When SWI was compared with T2WI, q was 3.1814925, 0.01 < P = 0.0104, rejecting the null hypothesis, and the difference was statistically significant. When DTI was compared with T2WI, q was 4.3463598, P = 0.004, and the difference was statistically significant. When DWI was compared with SWI, q was 2.7157317, P = 0.067, and the difference was not statistically significant. When DWI was compared with DTI, q was 0.879182, P = 0.797, and the difference was not statistically significant. When SWI was compared with DTI, q was −2.9767478, 0.01 < P = 0.031, rejecting the null hypothesis, and the difference was statistically significant (see Table 1).

            Table 1

            Comparison of Imaging Methods.

            Comparison q P
            DWI and T2WI6.2614711<0.01
            SWI and T2WI3.1814925>0.01, <0.05
            DTI and T2WI4.3463598<0.01
            DWI and SWI2.7157317>0.05
            DWI and DTI0.879182>0.05
            DTI and SWI2.9767478>0.01, <0.05

            DTI, diffusion tensor imaging; DWI, diffusion-weighted imaging; SWI, susceptibility-weighted imaging; T2Wi, T2-weigheted imaging.

            Discussion

            Emboli caused by atherosclerosis often appear in human blood. These emboli can enter and block the cerebral vessels with the blood circulation of human body, and finally lead to cerebral infarction and other diseases. This is the pathogenesis of cerebral infarction. Cerebral infarction seriously affects human health, so it is of great significance to carry out precise treatment.

            DWI can display the information associated with various types of cerebral infarction, and has become the gold standard for the identification of the core of cerebral infarction lesions. The application of DWI in clinical practice will be increased [2]. Through DWI technology, the area of decreasing dispersion and increasing dispersion can be clearly displayed on the image. Through the analysis of DWI in 3,236 patients with acute ischemic cerebral infarction, the prevalence rate for patients with acute ischemic cerebral infarction under the premise of negative DWI was 6.8% [3].

            DWI can effectively predict acute middle cerebral artery occlusion associated with intracranial atherosclerotic disease [4]. Thin-slice DWI has advantages in the diagnosis of small lesions of unilateral localized infarction [5]. DWI has the most advantageous diagnostic effect in the detection and differentiation of early and very early cerebral infarction and cerebral ischemia, as well as the definition of the core area of infarction [6]. DWI with apparent diffusion coefficient (ADC) images has a significant advantage in the differential diagnosis of cytotoxic edema (decreased ADC) from vasogenic edema (increased ADC) [7]. DWI can be used for recanalization of thrombectomy at the site of cerebral infarction with good results [8]. DWI combined with thrombolytic reperfusion therapy is helpful to analyze whether further craniectomy is necessary in patients with cerebral infarction [9]. DWI and ADC images have obvious advantages in the differential diagnosis of cerebral infarction and have guiding significance for the prognosis of patients with cerebral infarction [10]. The differential detection of the lesion area by DWI can add valuable information to the assessment of the progress of the underlying microvascular disease [11]. The diagnosis of cerebral infarction by 3D DWI is obviously better than that by conventional DWI, and its combination with angiography has a great advantage in the differentiation of cerebral infarction [12]. Combined DWI is helpful to increase the accuracy of prediction of cerebral infarction after a TIA [13]. Combined DWI and SWI has obvious advantages in the diagnosis of cerebral infarction, and SWI is helpful to identify intravascular thrombosis in the lesion area, which is helpful for subsequent intravascular thrombolytic therapy [14]. However, DWI also has limitations in the diagnosis of cerebral infarction. Even if the best efforts cannot inhibit the growth of early cerebral infarction lesions, the growth of lesions should be considered and measured in the treatment of patients with cerebral infarction [15].

            SWI and DTI also play a special role in the diagnosis of cerebral infarction. The thrombosis sites and ranges of cerebral infarction lesions detected by SWI within 72 hours have similar thrombosis compositions, which can be considered to predict the severity of clinical lesions and short-term clinical prognosis [16]. Changes caused by cerebral infarction can be clearly shown on DTI images [17]. DTI can distinguish and judge the severity of cerebral infarction by comparing the cerebral blood flow (CBF) and average ADC of the cerebral infarction lesion and its mirror area with the CBF in the mismatch area of S(CBF) and S(DWI) [18]. It can clearly show the manifestations of tendon injury in each stage of acute ischemic cerebral infarction [19], and distinguish the therapeutic effect of a patient with cerebral infarction [20]. Moreover, DTI is of great significance in the detection and identification of early cerebral infarction lesions and the evaluation of neurological recovery after cerebral infarction [21].

            Conclusion

            From comparison of the signal intensity of lesions, the imaging performance was in the order DWI > DTI > SWI > T2WI for the diagnosis of cerebral infarction (see Figures 14). Combined imaging is obviously better than single imaging.

            Figure 1

            T2-Weighted Imaging of a Patient.

            Figure 2

            Diffusion-Weighted Imaging of the Same Patient as in Figure 1 at the Same Level.

            Figure 3

            Diffusion Tensor Imaging of the Same Patient as in Figure 1 at the Same Level.

            Figure 4

            Susceptibility-Weighted Imaging of the Same Patient as in Figure 1 at the Same Level.

            References

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            Author and article information

            Journal
            CVIA
            Cardiovascular Innovations and Applications
            CVIA
            Compuscript (Ireland )
            2009-8782
            2009-8618
            May 2021
            May 2021
            : 5
            : 4
            : 283-287
            Affiliations
            [1] 1School of Biomedical Engineering, Xinhua College of Sun Yat-Sen University, Guangzhou, 510520, China
            Author notes
            Correspondence: Xiao-mei Li, The First Affiliated Hospital of Sun Yat-sen University, E-mail: 197766051@ 123456qq.com
            Article
            cvia.2021.0012
            10.15212/CVIA.2021.0012
            917717f2-4463-45dd-a593-992448782b05
            Copyright © 2021 Cardiovascular Innovations and Applications

            This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

            History
            : 23 February 2021
            : 10 March 2021
            : 12 March 2021
            Categories
            Research Papers

            General medicine,Medicine,Geriatric medicine,Transplantation,Cardiovascular Medicine,Anesthesiology & Pain management
            diffusion tensor imaging,susceptibility-weighted imaging,cerebral infarction,T2-weighted imaging,diffusion-weighted imaging

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