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13 Background: The measurement of ADC of water in  brains of stroke patients is used in developing tissue models of  reversible from irreversible injury. Cerebrospinal fluid (CSF) has a  higher ADC and T2 value than parenchyma and measurement of lesion ADC  by conventional EPI methods may be overestimated by the presence of CSF  in sulci and perivascular spaces. We investigated whether the  suppression of signal from CSF using an inversion recovery MRI method  would give different ADC values than with the conventional DWI  technique.Methods: Thirteen consecutive patients with  stroke onset of less than 6 hours and an acute lesion on conventional  DWI were studied. Conventional isotropic DWI was a T2-weighted single  shot EPI technique with a b value of 1000 s/mm2. CSF suppression was  achieved by the addition of an inversion pulse (TI = 2200 ms) at  the beginning of the DWI sequence. The method is termed Fluid-Inversion  Prepared Diffusion (FLIPD), and it is a combination of FLAIR and DWI in  a single sequence. The region of the acute lesion was identified on the  conventional DWI and the ADC of that region was measured in both the  conventional and FLIPD ADC images.Results: In all 13  patients, FLIPD ADC was lower than conventional ADC. The mean (SD) of  the 13 patients’ lesion ADC was 0.587 (0.075) x 10-3 mm/s  with FLIPD and 0.696 (0.078) x 10-3 mm/s with conventional  DWI (p &lt; 0.0001). The distribution of ADC values in all voxels  pooled across all subjects indicated a narrower distribution of for  FLIPD ADC (SD = 0.128 vs. 0.220 x 10-3 mm/s for lesions  and (SD = 0.151 vs. 0.514 x 10-3 mm/s for normal  brain). The reduced variance in FLIPD ADC improved the diagnostic  conspicuity of FLIPD ADC lesions.Conclusions: Suppression  of CSF leads to lesion ADC values more homogeneous and greater than  15% lower than with conventional EPI DWI techniques. We suggest that  FLIPD ADC measurements are more accurate and give more diagnostically  useful images than conventional ADC maps. Because FLIPD measures water  diffusion within parenchyma only, it should be more sensitive to  ischemic changes.

stroke

Conventional Diffusion Weighted Imaging In Acute Stroke Overestimates Apparent Diffusion Coefficient (ADC): Improved Accuracy of ADC Measurements of Brain Using Fluid-Inversion Prepared Diffusion (FLIPD) Imaging