Editorial comment--ADC and metabolites in stroke: even more confusion about diffusion?

Recently, permanent and transient early ADC renormalization has been reported in stroke patients.1–3 Several other articles with different focus report on patients with substantial decrease of lesion volume from initial DWI to outcome T2-weighted imaging. Differences in the reported rates of patients showing ADC normalization may be due to varieties in imaging time points and application of thrombolytic therapy. These reports resulted in some confusion among stroke physicians about the clinical value of the ADC. The accompanying article by Nicoli et al provides novel insights into the pathophysiological basis of DWI in patients with acute ischemic stroke. Using spectroscopic imaging, the authors describe a heterogeneous cellular metabolic injury within the region of decreased ADC values. This finding may help us to …