Additional Value of Susceptibility Weighted Imaging in the Evaluation of Acute Ischemic Stroke Patients

Objective: The aim of our study was to prove susceptibility weighted imaging (SWI) as a useful adjunct to routine magnetic resonance imaging (MRI) in the evaluation of acute ischemic stroke patients. Material and Methods: We performed a prospective study of 65 patients presenting with acute ischemic stroke in whom the diagnoses were based on clinical findings and diffusion weighted imaging (DWI). All patients were referred to computed tomography (CT) and complete brain MRI examinations within 24 hours of stroke onset. Results: SWI was able to detect hemorrhage in 12 out of 65 patients (18%) as either macrohemorrhages or petechial microhemorrhagic forms which were later not seen on CT or routine MRI sequences. Out of these 12 patients, 6 (50%) showed macrohemorrhages and the remaining 6 (50%) had petechial microhemorrhages. SWI was able to detect all microhemorrhages (100%) which otherwise would not be picked up by other imaging modalities. A prominent vessel sign was detected in 53 out of 65 (82%) patients in the vicinity of the acute ischemic brain territory. Hyperdense artery sign on CT in 31 (48%) patients and hyperintense artery sign on fluid attenuated inversion recovery (FLAIR) sequence in 21 (32%) patients were present. However, on SWI sequences, susceptible vessel sign (SVS) was present in 55 out of 65 (85%) patients with different major intracranial artery locations. Conclusion: SWI has been proven to provide invaluable additive information which otherwise would not be able to be picked up by other imaging modalities in the evaluation of acute ischemic stroke pa tients.