Susceptibility weighted magnetic resonance imaging of brain: A multifaceted powerful sequence that adds to understanding of acute stroke

Abstract

Context:To evaluate the additional information that susceptibility weighted sequences and datasets would provide in acute stroke.Aims:The aim of this study were to assess the value addition of susceptibility weighted magnetic resonance imaging (SWI) of brain in patients with acute arterial infarct.Materials and Methods:All patients referred for a complete brain magnetic resonance imaging (MRI) between March 2010 and March 2011 at our institution had SWI as part of routine MRI (T1, T2, and diffusion imaging). Retrospective study of 62 consecutive patients with acute arterial infarct was evaluated for the presence of macroscopic hemorrhage, petechial micro-bleeds, dark middle cerebral artery (MCA) sign and prominent vessels in the vicinity of infarct.Results:SWI was found to detect hemorrhage not seen on other routine MRI sequences in 22 patients. Out of 62 patients, 17 (10 petechial) had hemorrhage less than 50% and 5 patients had greater than 50% area of hemorrhage. A “dark artery sign” due to thrombus within the artery was seen in 8 out of 62 patients. Prominent cortical and intraparenchymal veins were seen in 14 out of 62 patients.Conclusions:SWI has been previously shown to be sensitive in detecting hemorrhage; however is not routinely used in stroke evaluation. Our study shows that SWI, by virtue of identifying unsuspected hemorrhage, central occluded vessel, and venous congestion is additive in value to the routine MR exam and should be part of a routine MR brain in patients suspected of having an acute infarct.

Diffusion MRI of the Brain and Susceptibility Weighted Imaging (SWI) in Evaluation of Patients with Acute Stroke

“…In contrary to our research, the research of Naik et al [22] found that of the 22 cases investigated with hemorrhage, 17 had petechial hemorrhage and 5 cases had macro-hemorrhage within the infarct bleeds. Also, they reported that SWI can provide vital information on haemorrhage and vascular thrombosis, which could be useful in determining the severity of an acute stroke.…”

“…On the other hand, Darwish et al [21] found that 11 cases (55%) and 9 cases (45%) have infarctions of the right and left MCA territories respectively. Our research agreed with Naik et al [22] showed that the infarcts with hemorrhage are distributed as follows: 11-middle cerebral artery, 1-anterior cerebral artery, 5-posterior cerebral artery, 1anterior inferior cerebellar artery, 3-superior cerebellar artery, and 1-posterior inferior cerebellar artery.…”

Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

“…Susceptibility-weighted sequences such as T2 * GRE and SWI are central to the MRI-based acute stroke workup ( 31 , 32 ). SWI sequences provide reliable information on a potential hemorrhagic transformation but may also outline the occluded vessel depending on clot composition ( 9 , 13 , 15 , 33 , 34 ).…”

Social cognition impairments after aneurysmal subarachnoid haemorrhage: Associations with deficits in interpersonal behaviour, apathy, and impaired self-awareness

“…is a useful technique in detecting micro-bleeds (Liu et al, 2017;Naik, Viswamitra, Kumar, & Srinath, 2014;Ryan et al, 2015) and diffuse neuropathology detected with SWI has been related to ToM deficits in paediatric TBI patients (Ryan et al, 2015). Unfortunately, DTI and SWI sequences were not part of the imaging protocol during the time of our study.…”