How are other conditions with areas of hyperintensity on diffusion-weighted imaging differentiated from acute stroke?

Updated: Dec 19, 2018
  • Author: Souvik Sen, MD, MPH, MS, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

From the clinical experience at the University of North Carolina at Chapel Hill Stroke Center, the following differential for areas of hyperintensity on DWI was generated:

  • Subacute ischemic stroke - Usually takes 7-14 days for hyperintensity to subside

  • Hemorrhagic stroke - Usually bright on T1-WI

  • Multiple sclerosis plaque - Also bright on fluid-attenuated inversion recovery (FLAIR) and T2-WI

  • Traumatic brain injury - History of trauma

  • Brain abscess - Ring enhancement on contrast MRI

  • Choroid plexus - Usually intraventricular in location, may be bilateral

  • Epidermoid - Usually extra-axial in location

  • Air-bone interface - Commonly bilateral, in the temporal bone

  • T2 shine through - Associated with abnormal T2-WI and normal ADC map


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