DIAGNOSTIC ACCURACY OF APPARENT DIFFUSION COEFFICIENT FOR THE DIAGNOSIS OF ACUTE ARTERIAL STROKE KEEPING DIFFUSION WEIGHTED IMAGING AS GOLD STANDARD
DOI:
https://doi.org/10.18623/rvd.v23.5973Keywords:
Diffusion Magnetic Resonance Imaging, Ischemic Stroke, Magnetic Resonance Imaging, Sensitivity and Specificity, StrokeAbstract
Objective To determine the diagnostic accuracy of apparent diffusion coefficient for diagnosis of acute arterial stroke taking diffusion weighted imaging as gold standard. Study Design Cross sectional validation study. Duration and Place of Study Conducted from December 2025 to March 2026 at Radiology Department, Ittefaq Hospital Trust, Lahore. Methodology A total of 166 patients aged 30–70 years with clinical diagnosis of acute arterial stroke were included. Magnetic resonance imaging was performed and apparent diffusion coefficient and diffusion weighted imaging findings were recorded. Mean and standard deviation was calculated for quantitative variables while frequency and percentage were used for qualitative variables. Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value and negative predictive value was calculated by 2×2 table. Results Mean age was 53.89 ± 8.52 years and mean body mass index was 28.11 ± 3.12 kg/m². Males were 53.6% and females 46.4%. Apparent diffusion coefficient showed sensitivity 70%, specificity 80% and overall diagnostic accuracy 73%. Positive predictive value was 86% while negative predictive value was 59%. Conclusion Apparent diffusion coefficient is moderately accurate for diagnosis of acute arterial stroke but cannot be used alone as compared to diffusion weighted imaging.
References
Arafat MT, Alam SZ, Liza TY, Afrin T, Bhuiya MMR. MRI as a diagnostic tool for the determination of acute ischaemic stroke: a study in a tertiary care hospital. Annals of International Medical and Dental Research. 2023;9(3):40–47. DOI: https://doi.org/10.53339/aimdr.2023.9.3.6
Babar M, Zafar U, Shahzad I, Raja AJ, Mannan M, Zafar H. Diagnostic accuracy of diffusion weighted magnetic resonance imaging for differentiation of brain abscesses from brain lesions taking surgical findings as gold standard. Pakistan Journal of Medical and Health Sciences. 2020;14(3):574.
Chaturvedi A, Singh D, Sinha P, Prasad R. Diagnostic accuracy of diffusion-weighted MR imaging versus CT brain in hyperacute stroke – a prospective study. Journal of Evidence Based Medicine and Healthcare. 2021;8(28):2514–2519. DOI: https://doi.org/10.18410/jebmhi/2021/465
Engelter ST, Wetzel SG, Bonati LH, Fluri F, Lyrer PA. The clinical significance of diffusion-weighted MR imaging in stroke and TIA patients. Swiss Medical Weekly. 2008;138:729–740.
Hladky SB, Barrand MA. Alterations in brain fluid physiology during the early stages of development of ischaemic oedema. Fluids and Barriers of the CNS. 2024;21(1):51. DOI: https://doi.org/10.1186/s12987-024-00534-8
Iftikhar A, Adil Z, Majid A, Muhammad A, Saleem R, Saleem I. Comparative diagnostic performance of CT and MRI in acute ischemic stroke: a retrospective analysis from a tertiary care center. Pakistan Journal of Neurological Surgery. 2025;29(3):301–309. DOI: https://doi.org/10.36552/pjns.v29i3.1129
Jin D, Su X, Jin Y, Gu Y, Yang J, Wang Q, et al. Diagnostic value of MRI perfusion-weighted imaging and diffusion-weighted imaging parameters in cerebral apoplexy. American Journal of Translational Research. 2023;15(2):1097–1106.
Johansson J, Lagerstrand K, Björkman-Burtscher IM, Laesser M, Hebelka H, Maier SE. Normal brain and brain tumor ADC: changes resulting from variation of diffusion time and/or echo time in pulsed-gradient spin echo diffusion imaging. Investigative Radiology. 2024;59(10):727–736. DOI: https://doi.org/10.1097/RLI.0000000000001081
Kalia M, Meijer HGE, van Gils SA, van Putten MJAM, Rose CR. Ion dynamics at the energy-deprived tripartite synapse. PLoS Computational Biology. 2021;17(6):e1009019. DOI: https://doi.org/10.1371/journal.pcbi.1009019
Kim Y, Lee SK, Kim JY, Kim JH. Pitfalls of diffusion-weighted imaging: clinical utility of T2 shine-through and T2 black-out for musculoskeletal diseases. Diagnostics. 2023;13(9):1647. DOI: https://doi.org/10.3390/diagnostics13091647
Li X, Su F, Yuan Q, Chen Y, Liu CY, Fan Y. Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: a narrative review. Quantitative Imaging in Medicine and Surgery. 2023;13(4):2712–2734. DOI: https://doi.org/10.21037/qims-22-750
Miyawaki EK, Wilcox DR, Kraft AW, Guenette JP. Dysarthria-facial paresis and rostral pontine ischemic stroke. Case Reports in Neurology. 2022;14(1):104–110. DOI: https://doi.org/10.1159/000522283
Mollah MNI, Hossain AKMA, Kabir MA, Deepa ZS, Miraj AKA, Bhuiyan MHU. Diagnosis of acute ischemic stroke by CT scan and diffusion weighted MRI. International Journal of Medical and Pharmaceutical Research. 2024;5(6):410–416.
Nukovic JJ, Opancina V, Ciceri E, Muto M, Zdravkovic N, Altin A, et al. Neuroimaging modalities used for ischemic stroke diagnosis and monitoring. Medicina. 2023;59(11):1908. DOI: https://doi.org/10.3390/medicina59111908
Okorie CK, Ogbole GI, Owolabi MO, Ogun O, Adeyinka A, Ogunniyi A. Role of diffusion-weighted imaging in acute stroke management using low-field magnetic resonance imaging in resource-limited settings. West African Journal of Radiology. 2015;22(2):61–66. DOI: https://doi.org/10.4103/1115-3474.162168
Purushotham A, Campbell BC, Straka M, Mlynash M, Olivot JM, Bammer R, et al. Apparent diffusion coefficient threshold for delineation of ischemic core. International Journal of Stroke. 2015;10(3):348–353. DOI: https://doi.org/10.1111/ijs.12068
Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, et al. Integrative approaches in acute ischemic stroke: from symptom recognition to future innovations. Biomedicines. 2023;11(10):2617. DOI: https://doi.org/10.3390/biomedicines11102617
Shay J, Malik A, Author S, Wagle B, Author L. Abstract 1122-000190: persistent DWI signal for 18 months in ischemic stroke patient with carotid web. Stroke: Vascular and Interventional Neurology. 2021;1(Suppl 1):e12046. DOI: https://doi.org/10.1161/SVIN.01.suppl_1.000190
Tong DC, Adami A, Moseley ME, Marks MP. Relationship between apparent diffusion coefficient and subsequent hemorrhagic transformation following acute ischemic stroke. Stroke. 2000;31:2378–2384.
Yu Y, Christensen S, Ouyang J, Scalzo F, Liebeskind DS, Lansberg MG, et al. Predicting hypoperfusion lesion and target mismatch in stroke from diffusion-weighted MRI using deep learning. Radiology. 2023;307(1):e220882. DOI: https://doi.org/10.1148/radiol.220882
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