The efficacy of 2D turbo gradient- and spin-echo diffusion-weighted imaging with non-Cartesian BLADE trajectory (TGSE-BLADE DWI) has not been well studied for acute stroke due to its long acquisition time. This study was performed to compare distortion, artifacts and image quality between single-shot echo planar imaging (SS-EPI) DWI and TGSE-BLADE DWI with acquisition time reduced to 1 min by simultaneous multi-slice (SMS) imaging, and to evaluate the diagnostic performance of TGSE-BLADE DWI for acute infarctions. Total 104 patients with a past history of stroke or symptoms suspicious for acute infarction or who had undergone surgery for brain tumor within two days were prospectively enrolled. Ten lesions in 9 patients were diagnosed as acute or subacute infarction and were detectable only in TGSE-BLADE DWI but not in SS-EPI DWI. Scores for geometric distortion, susceptibility artifacts, overall image quality, lesion conspicuity and diagnostic confidence were lower for SS-EPI DWI than TGSE-BLADE DWI (p ≤ .001). Distortion was significantly worse in SS-EPI DWI than TGSE-BLADE DWI (p <
.001). SNR of centrum semiovale was significantly higher in SS-EPI DWI than TGSE-BLADE DWI (p <
.001). One-minute TGSE-BLADE DWI showed better image quality than SS-EPI DWI in terms of distortion and artifacts, and higher diagnostic performance for acute infarctions.