Sebahat Nacar Dogan1, Aylin Hasanefendioglu Bayrak2, Rıdvan Yazgu3. 1. Department of Radiology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences Turkey, 34255, Istanbul, Turkey. sebahatdogan@yahoo.com. 2. Department of Radiology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences Turkey, 34255, Istanbul, Turkey. 3. Department of Neurology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey.
Abstract
PURPOSE: Despite considerable published information about the clinical-radiological correlation of medullary infarcts, no study has determined whether topographic evaluations are performed accurately among researchers. Our purpose in this study was twofold: to evaluate the topographic pattern of medullary infarcts on diffusion-weighted imaging by their radiological aspect, and to assess interobserver agreement on the topographic pattern. METHODS: We retrospectively reviewed our imaging and clinical database for patients admitted to our radiology department between January 2014 and September 2019. Two radiologists evaluated the imaging studies independently. Consensus data were used in the analysis. RESULTS: The retrospective review yielded 92 patients with medullary infarction. The affected vascular territories were lateral (n = 58), anteromedial (n = 28), posterior (n = 3), and anterolateral (n = 1). Two patients had hemimedullary infarction. The rostrocaudal levels of the medullary infarct were superior (n = 34), middle (n = 31), inferior (n = 4), superior-middle (n = 13), and middle-inferior (n = 10). The medullary infarcts were divided into two types: lateral (n = 62) and medial (n = 28). The affected vascular territories differed with rostrocaudal topography of medullary infarct (p = 0.003). Excellent interobserver agreement was found for type of medullary infarct, compared with moderate for vascular territory and fair for rostrocaudal topography. The anterolateral and posterior territories were the most often misdiagnosed, while the level with the most disagreements in rostrocaudal topography was middle. CONCLUSION: The accurate topographic evaluation of a medullary infarct can be an important basis for investigating stroke etiology. However, correct topographic evaluation may not always be available and smaller territories such as anterolateral and posterior should be assessed carefully.
PURPOSE: Despite considerable published information about the clinical-radiological correlation of medullary infarcts, no study has determined whether topographic evaluations are performed accurately among researchers. Our purpose in this study was twofold: to evaluate the topographic pattern of medullary infarcts on diffusion-weighted imaging by their radiological aspect, and to assess interobserver agreement on the topographic pattern. METHODS: We retrospectively reviewed our imaging and clinical database for patients admitted to our radiology department between January 2014 and September 2019. Two radiologists evaluated the imaging studies independently. Consensus data were used in the analysis. RESULTS: The retrospective review yielded 92 patients with medullary infarction. The affected vascular territories were lateral (n = 58), anteromedial (n = 28), posterior (n = 3), and anterolateral (n = 1). Two patients had hemimedullary infarction. The rostrocaudal levels of the medullary infarct were superior (n = 34), middle (n = 31), inferior (n = 4), superior-middle (n = 13), and middle-inferior (n = 10). The medullary infarcts were divided into two types: lateral (n = 62) and medial (n = 28). The affected vascular territories differed with rostrocaudal topography of medullary infarct (p = 0.003). Excellent interobserver agreement was found for type of medullary infarct, compared with moderate for vascular territory and fair for rostrocaudal topography. The anterolateral and posterior territories were the most often misdiagnosed, while the level with the most disagreements in rostrocaudal topography was middle. CONCLUSION: The accurate topographic evaluation of a medullary infarct can be an important basis for investigating stroke etiology. However, correct topographic evaluation may not always be available and smaller territories such as anterolateral and posterior should be assessed carefully.
Entities:
Keywords:
Diffusion-weighted imaging; Medullary infarct; Topography; Vascular zone