Abstract
BackgroundIschemic stroke is a major cause of death and disability. Thrombolytic therapy is a standard treatment stroke nowadays for ischemic strokes up to 4.5 h from start of symptoms. Although arterial occlusion can be detected by digital subtraction angiography (DSA), magnetic resonance angiography (MRA), and computed tomography angiography (CTA), the question about thrombus composition and formation times still might not be replied. The use of susceptibility weighted imaging (SWI) for detecting thrombus in acute ischemic stroke is getting to be a strongly investigated field. SWI can show the thrombus as a hypointense susceptibility vessel sign (SVS) in the affected area.ResultsNinety-seven of our patients showed thrombus in MRA study. M1 segment was the most affected MCA segment representing about 57.6%. SWI detected intra-arterial thrombus in 122 patients compared to 97 patients detected by MRA (P = 0.0002). All patients had positive susceptibility sign. 88.8% of patients with positive thrombus in SWI had solitary thrombus, and 11.2% has multiple thrombi; on the other hand, MRA fails to detect any distant thrombi. 81% of patients with abnormally prominent vessel sign (APVS) showed parenchymal changes in these areas. On the other hand, deep structures, namely caudate nucleus, internal capsule and lentiform nucleus, are the least affected areas. All patients with abnormally prominent vessel sign showed arterial occlusion, and only 9 patients with no APVS showed arterial occlusion (P = 0.0001).ConclusionSWI plays an important role in the detection of peripheral thrombi in patients with acute ischemic stroke. Both SWI and MRA might complement each other for visual detection of occluded vessel. We recommend implementation of SWI into routine acute stroke MRI protocols.
Highlights
Ischemic stroke is a major cause of death and disability
The aim of the current study is to assess the value of susceptibility weighted imaging in assessment of intraarterial thrombus in correlation with magnetic resonance angiography (MRA) and diffusion weighted imaging in patients with acute ischemic infarction (Figs. 1, 2, 3, 4)
M1 segment was the most affected middle cerebral artery (MCA) segment representing about 57.6%
Summary
Ischemic stroke is a major cause of death and disability. Thrombolytic therapy is a standard treatment stroke nowadays for ischemic strokes up to 4.5 h from start of symptoms. The use of susceptibility weighted imaging (SWI) for detecting thrombus in acute ischemic stroke is getting to be a strongly investigated field. SWI can show the thrombus as a hypointense susceptibility vessel sign (SVS) in the affected area. Ischemic stroke is a major cause of death and disability, and thrombolytic therapy is the only proven treatment for those patients within 3 or 4 h of symptom onset [1]. The use of susceptibility weighted imaging (SWI) in the visualization of thrombi in acute ischemic stroke has become of major interest [12,13,14]. Using the fact that thrombus synthesis is different and only the acute phase of thrombus can show SVS on SWI, we hypothesized that susceptibility reflects the structure of thrombus and its time of formation
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