E5276. The Underappreciated Utility of High-Resolution DWI in Modern Neuroimaging
Authors
Alexander Kuehne;
Yale School of Medicine
Mehmet Adin;
Yale School of Medicine
Amit Mahajan;
Yale School of Medicine
Long Tu;
Yale School of Medicine
Background
Slice thickness for DWI in neuroimaging is currently routinely set to 5 mm. Historically, a 1–2-mm gap was used to speed coverage of brain anatomy. Newer MRI scanners and protocols may easily perform 2–3-mm DWI without any additional time needed. The primary clinical utility of DWI is early ischemic stroke detection and tumoral characterization. High resolution DWI is easy to implement and has wide application in characterization of transient ischemic attack (TIA), transient global amnesia (TGA), posterior circulation stroke, stroke quantification, among other scenarios. High resolution DWI (1 × 1 × 2 mm or 2 × 2 × 4 mm) has been shown to significantly decrease mean error in stroke infarct volume measurement compared to conventional DWI (4 × 4 × 8 mm).
Educational Goals / Teaching Points
Our educational goals are to familiarize the radiologist with current standards of perfusion/DWI, focusing on current standard usage and slice thickness guidelines. Highlight the utility of decreasing slice thickness and ability to detect further pathology, i.e., TIA, TGA, etc. Review imaging utility of DWI in case-based format. Highlight key imaging features of specific pathology and atypical presentations. Review imaging characteristics that would help to narrow the differential diagnosis.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We plan to demonstrate, with multiple images obtained at our institution, the utility of high-resolution DWI and its ability to detect further pathology with decreased slice thickness including examples such as TIA, TGA, posterior circulation strokes, and stroke quantification.
Conclusion
Given the advantages of 2–3-mm DWI, and the capability of newer MRI scanners to perform scans at this slice thickness with no significant change in scanning time, we propose further evaluation of the feasibility of incorporating high resolution DWI into standard protocols. This implementation can potentially be performed with minimal impact in radiologist workflow and can initially be targeted for specific scenarios (stroke detection/quantification, characterization of TIA, etc.). Further research is needed to evaluate center specific potential changes in workflow/requisites for implementation of protocol changes.
