The Value of Magnetic Resonance Susceptibility-Weighted Imaging in the Early Detection of Hemorrhagic Transformation in Acute Stroke
Iraqi Postgraduate Medical Journal,
2020, Volume 19, Issue 2, Pages 98-109
Stroke is rapidly increasing clinical signs of focal (or global) disturbance of cerebral function that
last more than 24 hours. Magnetic Resonance Susceptibility-Weighted Imaging (MRI-SWI) is
especially helpful in the detection of calcifications and micro-hemorrhages, which are both
characterized by low signal. Thus allowing a significant improvement compared with T2* GE and
other MRI sequences.
Study the value of MR SWI in the early detection of hemorrhage in an acute ischemic stroke and
compare the findings of SWI with Gradient and conventional MR sequences.
PATIENTS AND METHODS:
This is a cross sectional analytic study was conducted between October 2016 to October 2017,
at the MRI and Computed tomography (CT) units at Al-Imamian Al-Kadhimyian medical city,
Baghdad, Iraq, 100 patients (64 males and 36 females) with signs and symptoms of acute stroke
within 72 hours of attack and positive findings in Diffusion-weighted magnetic resonance
imaging (DWI MRI). The ages ranged between 42 and 83 years (mean age 62.8 years old).
Exclusion Criteria: patients with evidence hemorrhagic infarction in CT, patients with stroke-like
symptoms but CT and MRI finding show findings not consistent with signs of stroke, patients with
previous intracranial surgery or trauma that distort brain anatomy, patients with history of >72
hours, or show normal DWI sequence (no restriction), patients with unstable vital signs and
the general MRI contraindication. CT was done in the emergency department, then an MRI study
was done for all patients. MRI examination was done with the following sequences: T2 Weighted
axial, Fluid attenuated inversion recovery (FLAIR) T2 coronal, T1 Weighted axial and sagittal,
Diffusion-Weighted Image (DWI) Axial, Gradient Echo 2D axial T2*, and Venous Bold (SWI) in
axial plane were done for all patients. Hemorrhagic transformation was diagnosed on the basis of
the hypo intense blooming region in the infarct area on SWI. Statistical Analysis using SPSS 16.00
Statistical significance was considered whenever the p-value was equal or less than 0.05.
In CT 90 patients (90%) have abnormal CT finding consistent with ischemia, 10 patients (10%)
have normal CT, in all cases no hemorrhage nor calcification was detected. In MRI SWI 23 patients
(23%) show areas of hemorrhage. In MRI GRADIENT sequence 20 patients show areas of
hemorrhage (20%). In MRI T2 sequence 8 patients show areas of hemorrhage (8%). In MRI T1
sequence 3 patients show areas of hemorrhage (3%). SWI demonstrated 100% relative sensitivity.
Susceptibility-Weighted Imaging (SWI) is an important and sensitive technique that permits early
and accurate detection of hemorrhagic transformations within an area of acute cerebral infarction.
SWI is more sensitive than 2D GRE T2WI, T2WI and T1WI.
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