Role of susceptibility weighted imaging in acute ischemic stroke

Abstract

Background: stroke is a clinical syndrome of rapidly developing symptoms and signs of focal loss of cerebral function without apparent cause other than vascular origin, lasting 24 hours at least, or may lead to death before this. Hemorrhagic transformation (HT) is defined as hemorrhagic change in ischemic brain and includes a wide range of radiologic phenomena, from petechial hemorrhage to frank hematoma with mass effect. Objective: in our study, we aimed to determine the diagnostic value of susceptibility weighted image in detection of cerebral micro bleeds and prediction of hemorrhagic transformation in patients with acute ischemic stroke and their impact on choosing the most appropriate therapeutic protocol. Patients and Methods: this study included 28 patients with acute ischemic stroke. Patients admitted in Neurology Department of Nasser Institute Hospital within 72 h after the onset of the neurological symptoms, during the study period from 1/1/2018 to 30/8/2018, their age ranged between 23-85 years. Results: SWI image was a highly sensitive MRI sequence for detection and evaluation of cerebral micro bleeds especially on 3T magnet. Microbleeds were traditionally categorized according to their presumed underlying etiology into lobar (CAA related pathology) and deep (arteriosclerosis) microbleeds. There was a highly significant positive correlation between both age and hypertention with number of both cortical and basal ganglionic microbleeds. While, the age was obviously more correlated with cotical microbleeds, hypertention, in contrast, was more correlated with basal ganglionic microbleeds. Conclusion: presence of microbleeds in cerebral infarct lesions requires a comprehensive assessment for the therapeutic option, especially when using thrombolytic therapy or anticoagulants, but a relatively small number of microbleeds would not affect safety when using antiplatelet therapy.