Diagnostic Accuracy of Diffusion-Weighted MRI and Non-contrast CT in Hyperacute Ischemic Stroke
| Author | Basem Bahakeem | en |
| Author | Mohammad Khalil | en |
| Author | Alaa Alkhotani | en |
| Author | Amal Alkhotani | en |
| Author | Taghreed Alsinani | en |
| Author | Rakan Bokhari | en |
| Author | Humaira Waseem | en |
| Author | Amber Hassan | en |
| Author | Maher Kurdi | en |
| Orcid | Alaa Alkhotani [0000-0002-6528-9592] | en |
| Orcid | Amal Alkhotani [0000-0001-8310-1875] | en |
| Orcid | Maher Kurdi [0000-0002-8979-3849] | en |
| Issued Date | 2026-01-31 | en |
| Abstract | Background: Prompt detection of acute ischemic stroke is essential for effective treatment and improved clinical outcomes. Diffusion-weighted imaging (DWI) and non-contrast computed tomography (NCCT) are commonly used imaging tools; however, their relative diagnostic accuracy within the hyperacute phase (≤ 6 hours) requires further clarification. Objectives: This study aimed to evaluate the diagnostic accuracy of NCCT compared with DWI magnetic resonance imaging (MRI) as the reference standard in patients presenting within 6 hours of symptom onset. Methods: This prospective diagnostic accuracy study included 84 consecutive eligible cases presenting with symptoms suggestive of acute ischemic stroke within 6 hours of onset. All patients underwent NCCT followed by DWI MRI. The DWI MRI was predefined as the sole reference standard. Neuroimaging was evaluated by an independent radiologist blinded to clinical data and to the findings of the alternate imaging modality. Diagnostic performance of NCCT was calculated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and 95% confidence intervals (CIs). Results: Among the 84 patients, DWI identified 53 patients as positive for acute ischemic stroke. NCCT correctly identified 45 of these 53 DWI-positive cases, yielding a sensitivity of 84.9% (95% CI: 72.4% - 92.1%). It also correctly identified 24 of 31 DWI-negative cases, resulting in a specificity of 77.4% (95% CI: 59.8% - 89.4%). There were 8 false-negative cases (15.1%) and 7 false-positive cases (22.6%). Overall diagnostic accuracy of NCCT was 82.1% (69/84). Conclusions: Diffusion-weighted imaging demonstrated higher sensitivity than NCCT for detecting hyperacute ischemic stroke. While NCCT remains essential for rapid exclusion of intracranial hemorrhage, DWI may provide complementary diagnostic value when available. These findings should be interpreted cautiously and require confirmation in larger multicenter studies. | en |
| DOI | https://doi.org/10.5812/ans-169230 | en |
| URI | https://brieflands.com/journals/ans/articles/169230 | en |
| Keyword | Acute Ischemic Stroke | en |
| Keyword | Diffusion-Weighted MRI | en |
| Keyword | Non-contrast CT | en |
| Keyword | Early Ischemic Changes | en |
| Keyword | Diagnostic Accuracy | en |
| Publisher | Brieflands | en |
| Title | Diagnostic Accuracy of Diffusion-Weighted MRI and Non-contrast CT in Hyperacute Ischemic Stroke | en |
| Type | Research Article | en |