Combination of standard axial and thin‐section coronal diffusion‐weighted imaging facilitates the diagnosis of brainstem infarction

BACKGROUND AND PURPOSE: Although diffusion‐weighted imaging (DWI) is a very sensitive technique for the detection of small ischemic lesions in the human brain, in particular in the brainstem it may fail to demonstrate acute ischemic infarction. In this study, we sought to evaluate the value of additional thin‐section coronal DWI for the detection of brainstem infarction. METHODS: In 155 consecutive patients (median age 69 [interquartile range, IQR 57–78] years, 95 [61.3%] males) with isolated brainstem infarction, MRI findings were analyzed, with emphasis on ischemic lesions on standard axial (5 mm) and thin‐section coronal (3 mm) DWI. RESULTS: On DWI, we identified ischemic lesions in the mesencephalon in 12 (7.7%), pons in 115 (74.2%), and medulla oblongata in 31 (20%) patients. In 3 (1.9%) cases—all of these with medulla oblongata infarction—the ischemic lesion was detected only on thin‐section coronal DWI. Overall, in 35 (22.6%) patients the ischemic lesion was more easily identified on thin‐section coronal DWI in comparison to standard axial DWI. In these, the ischemic lesions were significantly smaller (0.06 [IQR 0.05–0.11] cm(3) vs. 0.25 [IQR 0.13–0.47] cm(3); p < .001) in comparison to those patients whose ischemic lesion was more easily (6 [3.9%]) or at least similarly well identified (114 [73.5%]) on standard axial DWI. CONCLUSIONS: Since thin‐section coronal DWI may facilitate the diagnosis of brainstem infarction, we suggest its inclusion in standard stroke MRI protocols.