Background

Diffusion-weighted imaging (DWI) on magnetic resonance imaging (MRI) shows limited sensitivity in the acute-phase brainstem infarctions, including lateral medullary infarction (LMI), and the detailed characteristics of acute LMI patients with initially negative DWI-MRI findings have not been reported previously. Therefore, we aimed to investigate the differences in the backgrounds or symptoms of acute LMI patients with initially negative findings in standard axial DWI-MRI and those with positive findings.

Methods

In this retrospective cohort study, we collected the data for 35 consecutive acute LMI patients who were hospitalized in our hospital from January 2011 to December 2018. Initial standard axial DWI-MRI was assessed, and the patients were divided into positive and negative groups. The characteristics of the two groups were compared, and the usefulness of additional thin-slice coronal DWI-MRI was also investigated.

Results

Nine (26%) acute LMI patients were initially negative on standard axial DWI-MRI. The patients were independently associated with smoking history (78% vs. 23%, p = 0.021) and headache (78% vs. 31%, p = 0.046). Thin-slice coronal DWI-MRI showed positive findings in 50% of the patients with negative findings in standard axial DWI-MRI. All four patients with negative findings in both standard axial and thin-slice coronal DWI-MRI had smoking history and headache.

Conclusion

Smoking history and headache were associated with initial negative results in standard axial DWI-MRI in acute LMI. Additional thin-slice coronal DWI-MRI was sometimes useful in detecting acute LMI. Follow-up MRI is important for patients showing negative findings in initial DWI-MRI.

中文翻译：

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急性外侧延髓性脑梗死患者的弥散加权成像阴性结果。

背景

磁共振成像（MRI）上的弥散加权成像（DWI）显示，在急性期脑干梗塞（包括外侧延髓梗塞（LMI））中，敏感性有限，而且最初DWI-MRI阴性的急性LMI患者的详细特征尚无之前有报道。因此，我们旨在调查标准轴向DWI-MRI最初为阴性发现的急性LMI患者的背景或症状与阳性结果的区别。

方法

在这项回顾性队列研究中，我们收集了2011年1月至2018年12月在我院住院的35例急性LMI患者的数据。对初始标准轴向DWI-MRI进行了评估，并将患者分为阳性和阴性组。比较了两组的特征，并研究了额外的薄型冠状DWI-MRI的有用性。

结果

最初有9例（26％）急性LMI患者在标准轴向DWI-MRI上阴性。患者分别与吸烟史（78％vs. 23％，p  = 0.021）和头痛（78％vs. 31％，p  = 0.046）相关。薄型冠状DWI-MRI在50％的标准轴向DWI-MRI阴性患者中显示阳性结果。在标准的轴向和薄层冠状DWI-MRI检查中均阴性的所有四名患者都有吸烟史和头痛。

结论

吸烟史和头痛与急性LMI标准轴向DWI-MRI最初阴性结果相关。额外的冠状薄层DWI-MRI有时可用于检测急性LMI。对于初次DWI-MRI阴性的患者，随访MRI很重要。