{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T16:50:49Z","timestamp":1774543849484,"version":"3.50.1"},"reference-count":20,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Brainstem infarctions remain challenging to identify due to their small size, complex anatomy, and known limitations of conventional axial diffusion-weighted imaging (DWI), particularly in the posterior fossa. Thin-section coronal DWI may improve lesion conspicuity by providing higher spatial resolution and an orthogonal imaging perspective. To evaluate whether 3 mm thin-section coronal DWI improves lesion visualization and delineation compared with standard 4 mm axial DWI in patients with MRI-confirmed acute brainstem infarction. Materials and Methods: In this retrospective single-center study, 125 consecutive patients with isolated brainstem infarction confirmed by MRI (January 2021\u2013January 2024) were included. All patients underwent both axial and coronal DWI acquisitions. Lesions were classified by anatomical location and by the imaging plane providing better visualization (\u201ccoronal better\u201d vs. \u201cequal\u201d). Lesion volumes were calculated using manual segmentation. Image interpretation was performed independently by two neuroradiologists. Interobserver agreement was assessed using Cohen\u2019s kappa and intraclass correlation coefficient (ICC). Statistical analysis included both parametric and nonparametric tests, with confidence intervals reported. Results: Coronal DWI provided improved or equivalent lesion visualization in all cases. Improved visualization was most frequent in midbrain infarctions (100%) and in a subset of medullary lesions (26.7%). Lesions better visualized on coronal DWI were significantly smaller than those equally visualized (mean volume ~0.23 mL vs. ~0.55 mL, p &lt; 0.0001). Twelve midbrain and eight medullary lesions were identified only on coronal DWI within the imaging protocol, all showing confirmation on ADC and\/or FLAIR correlation. Interobserver agreement was substantial to excellent. Conclusions: Thin-section coronal DWI improves visualization and delineation of small brainstem infarctions, particularly in anatomically compact regions. These findings support its role as a complementary sequence rather than a replacement for standard axial imaging.<\/jats:p>","DOI":"10.3390\/medicina62040635","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:10:24Z","timestamp":1774537824000},"page":"635","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Added Value of Thin-Section Coronal DWI for Lesion Visualization in Acute Brainstem Infarction: A Retrospective Analysis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7904-1563","authenticated-orcid":false,"given":"Alberto","family":"Negro","sequence":"first","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4745-3061","authenticated-orcid":false,"given":"Mario","family":"Tortora","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Advanced Biomedical Sciences, University \u201cFederico II\u201d, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivano","family":"Palladino","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Advanced Biomedical Sciences, University \u201cFederico II\u201d, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-4673","authenticated-orcid":false,"given":"Laura","family":"Gemini","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1902-8649","authenticated-orcid":false,"given":"Ciro","family":"Riccio","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4049-3378","authenticated-orcid":false,"given":"Francesco","family":"Pacchiano","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Advanced Biomedical Sciences, University \u201cFederico II\u201d, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaele","family":"Iaccarino","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Bianco","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2084-7976","authenticated-orcid":false,"given":"Gianvito","family":"Pace","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0096-2598","authenticated-orcid":false,"given":"Simone","family":"Cepparulo","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5944-2984","authenticated-orcid":false,"given":"Arturo","family":"De Falco","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Tortora","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Advanced Biomedical Sciences, University \u201cFederico II\u201d, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Buono","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, AORN \u201cSan Giuseppe Moscati\u201d, Plesso Citt\u00e0 Ospedaliera Contrada Amoretta, 83100 Avellino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9011-0240","authenticated-orcid":false,"given":"Vincenzo","family":"D\u2019Agostino","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Ospedale del Mare (ASL NA1 Centro), Via Enrico Russo, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1053\/j.sult.2013.01.004","article-title":"Brainstem stroke: Anatomy, clinical and radiological 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