Importance of susceptibility weighted imaging (SWI) in management of cerebro-vascular strokes (CVS)

Abstract

IntroductionSusceptibility-weighted imaging offers information about any tissue that has a different susceptibility from its surrounding structures such as deoxygenated blood, hemosiderin, ferritin, and calcium. It can detect minute hemorrhages, old microbleeds as well as thrombosed veins or sinuses. PurposeThe aim of this work was to evaluate the importance of susceptibility weighted imaging (SWI) in management of cerebro-vascular strokes. Patients and methodsThe study was conducted upon 50 patients presenting with cerebro-vascular strokes within 72h after the onset of the neurological symptoms. All patients were subjected to non-contrast CT of the brain as well as MRI of the brain including susceptibility weighted MRI. ResultsAmong the 50 studied patients, 46 had infarctions (92%), while three patients had hematomas (6%) and one patient (2%) had no infarctions or hematomas but transverse sinus thrombosis. Among the 46 infarctions CT detected hemorrhagic transformation in two patients (4.3%) while the SWI detected hemorrhagic transformation in ten patients (21.7%). Both the CT and SWI detected the hematomas in three patients. SWI detected old micro-bleeds in eight patients out of 50 (16%), while CT could not detect any of these micro-bleeds. These eight patients included four with non-hemorrhagic infarctions, three with hematomas and one with early hemorrhagic transformation. SWI detected sinus thrombosis in two cases out of 50 (4%), one had hemorrhagic infarction, and the other had no visible brain insults on CT. Management was planned for each group according to the presence or absence of hemorrhagic transformation of infarction or associated old microbleeds. ConclusionsSusceptibility-weighted imaging is an important technique that allows accurate detection of early hemorrhagic transformations within acute infarctions as well as detecting old microbleeds thus alarming the treating physician about the devastating complication of anticoagulant therapies. Also SWI can early detect cerebral venous thrombosis. Thus SWI should be a routine sequence in the protocol of stroke imaging.