Evidence map›Paper›PMID 40127144›Full record

ArticleStroke2025

Diffusion Imaging Protocol Heterogeneity Biases Ischemic Core Volume, Location, and Clinical Associations in Acute Stroke.

Jonathan Rafael-Patiño, Elda Fischi-Gomez, Antoine Madrona, Veronica Ravano, Bénédicte Maréchal, Tobias Kober, Silvia Pistocchi, Alexander Salerno, Guillaume Saliou, Patrik Michel and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Jonathan Rafael-PatiñoDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0002-8960-5465
Elda Fischi-GomezDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0002-6506-2128
Antoine MadronaEcole Polytechnique Fédérale de Lausanne (EPFL), Switzerland (J.R.-P., A.M., V.R., T.K.).ORCID 0000-0002-8188-4180
Veronica RavanoDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0002-1532-9664
Bénédicte MaréchalAdvanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland (V.R., B.M., T.K.).ORCID 0000-0001-7866-2854
Tobias KoberDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0001-7598-9456
Silvia PistocchiDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0002-5427-4299
Alexander SalernoDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0001-8494-5527
Guillaume SaliouDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0003-3832-7976
Patrik MichelStroke Center, Neurology Service, Department of Clinical Neurosciences (P.M.), Lausanne University Hospital, Switzerland.ORCID 0000-0003-4954-7579
Roland WiestSupport Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Switzerland (R.W., R.M.K.).ORCID 0000-0001-7030-2045
Richard McKinleySupport Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Switzerland (R.W., R.M.K.).
Jonas RichiardiDepartment of Radiology (J.R.-P., E.F.-G., V.R., T.K., S.P., A.S., G.S., J.R.), Lausanne University Hospital, Switzerland.ORCID 0000-0002-6975-5634

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiffusion-weighted magnetic resonance imaging is essential for diagnosing ischemic stroke and identifying targets for emergency revascularization. Apparent diffusion coefficient (ADC) maps derived from diffusion-weighted magnetic resonance imaging are commonly used to locate the infarct core, but they are not strictly quantitative and can vary across platforms and sites due to technical factors. This retrospective study was conducted to examine how differences in ADC map generation, resulting from varied protocols across platforms and sites, affect the determination of infarct core size, location, and related clinical outcomes in acute stroke.

methodsIn this retrospective study, 726 patients with acute anterior circulation stroke from a cohort of 1210 unique visits to the Lausanne University Hospital between May 2018 and January 2021 were selected, excluding patients with poor quality imaging or no magnetic resonance imaging or clinical information available. Diffusion-weighted magnetic resonance imaging data were used to generate ADC maps as they would appear from different protocols: 2 simulated with low- and medium-angular resolution (4 and 12 diffusion gradient directions) and 1 with high-angular resolution (20 directions). Using DEFUSE criteria and image postprocessing, ischemic cores were localized; core volume, location, and associations to the National Institutes of Health Stroke Scale and modified Rankin Scale scores were compared between the 2 imaging sequences.

resultsSignificant differences were observed in the ADC distribution within white matter, particularly in the kurtosis and skewness, with the segmented infarct core volume being higher in protocols with reduced angular resolution compared with the 20-directions data (7.63 mL versus 3.78 mL). The volumetric differences persisted after correcting for age, sex, and type of intervention. Infarcted voxel's locations varied significantly between the 2 protocols. This variability affected associations between infarct core volume and clinical scores, with lower associations observed for 4-direction data compared with 20-direction data for the National Institutes of Health Stroke Scale at admission and after 24 hours, and modified Rankin Scale after 3 months, further confirmed by multivariate regression.

conclusionsImaging protocol heterogeneity leads to significant changes in the ADC distribution, ischemic core location, size, and association with clinical scores. Work is needed in standardizing imaging protocols to improve the reliability of ADC as an imaging biomarker in stroke management protocols to improve the reliability of ADC as an imaging biomarker in stroke management.

Indexed as

Brain IschemiaDiffusion Magnetic Resonance ImagingIschemic StrokeStrokeAgedAged, 80 and overFemaleHumansMaleMiddle AgedRetrospective Studiesdiffusion magnetic resonance imaginghospitalsischemic strokeretrospective studiesstrokewhite matter

Identifiers

PMID40127144
PMCPMC11932440

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.