A systematic review of current update in the role of diffusion weighted images and apparent diffusion coefficient in neonatal ischemic stroke

Background: Magnetic resonance imaging (MRI), together with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC), has been the mainstay of diagnostic imaging for neonatal ischemic stroke. This systematic review will describe the current research progress on DWI and ADC in neonatal ischemic stroke. Methods: The protocol for this study is available in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024543678). The studied population was all neonates (≤ 28 days old) who suffered from ischemic stroke and DWI or ADC was analyzed. The inclusion criteria were articles of any cross-sectional, case-control, cohort, or randomized controlled trial that were published in any language. To evaluate the risk of bias, we employed the Newcastle Ottawa Scale (NOS). Results: 17 studies were included in the systematic review, and only 4 (23.5%) had a good rating. There are 373 neonates with a gestational age ranging from 35 1/7 weeks old to 43 weeks old. Most neonates undergo MRI scans when they are < 10 days old and most studies come from the United States of America (USA) (n = 6) and the Netherlands (n = 3). The middle cerebral artery (MCA) is the most commonly affected vascular territory with 197 neonates (52.8%). Ten studies assess the utility of DWI and ADC in neonatal stroke, while the others incorporated DWI and ADC into a prediction modeling score to predict a disease entity or the prognosis. Infarctions faded on DWI within a week; by 14 days, increased diffusion and visible lesions appeared on T2-weighted images. Conclusion: Early use of DWI and ADC has been recommended for early detection of neonatal ischemic stroke. However, the progression of both of these sequences has been slow, with DWI and ADC being incorporated into prediction modeling tools.