ArticleJournal of stroke2021
Delayed Lesions on Diffusion-Weighted Imaging in Initially Lesion-Negative Stroke Patients.
Article in Journal of stroke, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Risk of Ischemic Stroke After Transient Ischemic Attack in Patients Receiving Comprehensive Versus Noncomprehensive Diagnostic Workup: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2025Pooled it
- Prognosis and distribution of ischemic stroke with negative diffusion-weighted imaging: a systematic review and meta-analysis.Frontiers in neurology · 2024Pooled it
- Review
- Limitations and Blind Spots of Diffusion-Weighted Imaging in the Evaluation of Acute Brain Ischemia: A Narrative Review.Journal of clinical medicine · 2026Review
- When stroke hides: A case of negative diffusion MRI.Radiology case reports · 2025Article
- Posterior circulation ischemic stroke: radiomics-based machine learning approach to identify onset time from magnetic resonance imaging.Neuroradiology · 2024Article
- Presenting Symptoms and Diffusion-Weighted MRI Positivity by Time After Transient Neurologic Events: A Pooled Analysis of 3 Cohort StudiesNeurology · 2024Article
- Perfusion deficits in thrombolysis-treated acute ischemic stroke patients with negative or positive diffusion-weighted imaging.BMC neurology · 2023Observational
- In-hospital clinical outcomes in diffusion weighted imaging-negative stroke treated with intravenous thrombolysis.BMC neurology · 2022Article
- Diffusion kurtosis imaging in patients with tissue-negative transient ischemic attack.Frontiers in neurology · 2022Article
- The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients.Diagnostics (Basel, Switzerland) · 2021Article
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Authors and funding
10 authors.
Funding
Abstract
background and purposeLesions on diffusion-weighted imaging (DWI) occasionally appear on follow-up magnetic resonance imaging (MRI) among initially DWI-negative but clinically suspicious stroke patients. We established the prevalence of positive conversion in DWI-negative stroke and determined the clinical factors associated with it.
methodsThis retrospective, observational, single-center study included 5,271 patients hospitalized due to stroke/transient ischemic attack (TIA) in a single university hospital during 2010 to 2017. Patients without initial DWI lesions underwent follow-up DWI imaging as a routine practice. Adjusted hazard ratios (aHRs) for recurrent stroke risk according to positive conversion were determined using Cox proportional hazard regression. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for positive conversion among initially DWI-negative patients were estimated.
resultsIn total, 694 (13.2%) patients (mean±standard deviation age, 62.9±13.7 years; male, 404 [58.2%]) were initially DWI-negative. Among them, 22.5% had positive-conversion on follow-up DWI. Positive conversion was associated with a higher risk of recurrent stroke (aHR, 3.12; 95% CI, 1.56 to 6.26). Early neurologic deterioration (aOR, 15.1; 95% CI, 5.71 to 47.66), atrial fibrillation (aOR, 6.17; 95% CI, 3.23 to 12.01), smoking (aOR, 3.76; 95% CI, 2.19 to 6.63), pre-stroke dependency (aOR, 1.62; 95% CI, 1.15 to 2.27), objective hemiparesis (aOR, 4.39; 95% CI, 1.90 to 10.32), longer symptom duration (aOR, 2.17; 95% CI, 1.57 to 3.08), high cholesterol (aOR, 4.70; 95% CI, 1.78 to 12.77), National Institutes of Health Stroke Scale score (aOR, 1.44; 95% CI, 1.08 to 1.91), and high systolic blood pressure (aOR, 1.01; 95% CI, 1.00 to 1.02) were associated with a higher incidence of lesions with delayed appearance. Regarding the location of lesions on follow-up DWI, 34.6% and 21.2% were in the cortex and brainstem, respectively.
conclusionsIn DWI-negative stroke/TIA, positive conversion is associated with a higher risk of recurrent stroke. DWI-negative stroke with factors related to positive conversion may require follow-up MRI for a definitive diagnosis.
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