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. 2022 Oct 27;12(11):2602. doi: 10.3390/diagnostics12112602

Table 2.

Summary of common neurological disorders associated with DWI changes.

DWI Location DWI Change in Time T2 FLAIR Other Features
Epilepsy - Commonly involves (1) cortex, (2) subcortical region, (3) hippocampus, (4) claustrum, (5) splenium (6) pulvinar
- Nonvascular distribution
Hyperintensity can occur within hours and resolve within days to weeks depending on severity and etiologies Hyperintensities may appear if structural lesions exist or irreversible cell death occurs Absent vascular occlusion
Ischemic stroke Distributed within vascular territories Hyperintensities can occur within minutes and reach a peak after days before gradually reducing Hyperintensities persist in the ischemia sites for years DWI reversal may occur after early reperfusion with t-PA or endovascular therapy
limbic encephalitis May involve uncus, amygdala, hippocampus Nonspecific patterns (requires further research) Autoimmune: bilateral mesial temporal lobe
Infectious: unilateral temporal lobe, insular involvement, absence of basal ganglion.
Two patterns raise concerns regarding seizure: (A) gyriform hippocampal restriction and (B) diffuse hippocampal diffusion restriction that spares the most medial temporal lobe structures
Transient global amnesia - Dot-like hyperintense lesions 1–2 mm in diameter
- Commonly in the lateral aspect of the hippocampus (CA-1 region)
Hyperintensity appears with a delay of 24–48 h after onset Hyperintensities highly detected 2–4 days after onset
CJD - Mainly affects striatum and cortex
- Gyriform hyperintensity correlates to location of periodic sharp-wave complex on EEG
Hyperintensity appears 0.5–7 (mean: 1.6) months after symptoms onset, is progressive and persistent over months, then disappears in the end phase Isointensity to mild hyperintensity
(DWI > T2 FLAIR)
Pulvinar sign (symmetrical hyperintensity in the posterior thalamic nuclei on DWI or T2WI) or hockey stick sign (affecting the dorsomedial thalamic nuclei) specific in vCJD, sometimes in sCJD
PRES Similar to T2WI Hypointense to isointense - Hyperintensities appear in the parieto-occipital, posterior frontal cortex, white matter
- Less commonly in the brainstem, basal ganglia, and cerebellum
DWI and ADC hyperintensity indicate vasogenic edema

DWI, Diffusion-Weighted Imaging; T2 FLAIR, T2-weighted-Fluid-Attenuated Inversion Recovery; CJD, Creutzfeldt–Jakob disease; EEG, Electroencephalography; vCJD, variant Creutzfeldt–Jakob Disease; sCJD, sporadic Creutzfeldt–Jakob Disease; PRES, Posterior reversible encephalopathy syndrome; ADC, Apparent diffusion coefficient.