TY - JOUR
T1 - Synergistic role of susceptibility-weighted imaging with diffusion-weighted imaging and magnetic resonance angiography in the evaluation of acute arterial stroke
AU - Rai, Santosh P.V.
AU - Sanyal, Pulastya
AU - Pai, Shivananda
AU - Achappa, Basavaprabhu
AU - Madi, Deepak
AU - MR, Pavan
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Objective: This study was performed to investigate whether diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) are more effective than conventional imaging modalities for evaluation of stroke and selection of candidates for thrombolytic therapy. Methods: Eighty patients who presented within 12 hours of onset of symptoms of brain ischemia underwent 1.5T magnetic resonance imaging. DWI and SWI were compared with conventional sequences (T1, T2, and fluid-attenuated inversion recovery [FLAIR]) and time-of-flight magnetic resonance angiography (TOF-MRA) to assess factors that affect stroke management and prognosis. Results: The volume of brain tissue showing hyperintensity was significantly greater than that showing diffusion restriction in patients with a >6-hour symptom onset. The hypointensity sign (susceptibility sign) on SWI showed a sensitivity of 66.7%, specificity of 87.5%, positive predictive value of 88.9, and negative predictive value of 63.6 compared with TOF-MRA. Micro-hemorrhagic foci were significantly associated with 27-mL infarcts on DWI (sensitivity, 71.4%; specificity, 85.0%). Patients with DWI–SWI mismatch showed better responses to thrombolytics. FLAIR–DWI mismatch helped to assess the time of stroke onset. Conclusion: DWI and SWI should be part of the routine imaging protocol in patients with acute stroke and serve as a decision-making tool for selection of patients for thrombolytic therapy.
AB - Objective: This study was performed to investigate whether diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) are more effective than conventional imaging modalities for evaluation of stroke and selection of candidates for thrombolytic therapy. Methods: Eighty patients who presented within 12 hours of onset of symptoms of brain ischemia underwent 1.5T magnetic resonance imaging. DWI and SWI were compared with conventional sequences (T1, T2, and fluid-attenuated inversion recovery [FLAIR]) and time-of-flight magnetic resonance angiography (TOF-MRA) to assess factors that affect stroke management and prognosis. Results: The volume of brain tissue showing hyperintensity was significantly greater than that showing diffusion restriction in patients with a >6-hour symptom onset. The hypointensity sign (susceptibility sign) on SWI showed a sensitivity of 66.7%, specificity of 87.5%, positive predictive value of 88.9, and negative predictive value of 63.6 compared with TOF-MRA. Micro-hemorrhagic foci were significantly associated with 27-mL infarcts on DWI (sensitivity, 71.4%; specificity, 85.0%). Patients with DWI–SWI mismatch showed better responses to thrombolytics. FLAIR–DWI mismatch helped to assess the time of stroke onset. Conclusion: DWI and SWI should be part of the routine imaging protocol in patients with acute stroke and serve as a decision-making tool for selection of patients for thrombolytic therapy.
UR - http://www.scopus.com/inward/record.url?scp=85067200414&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067200414&partnerID=8YFLogxK
U2 - 10.1177/0300060519840909
DO - 10.1177/0300060519840909
M3 - Article
C2 - 30971155
AN - SCOPUS:85067200414
SN - 0300-0605
VL - 47
SP - 2166
EP - 2176
JO - Journal of International Medical Research
JF - Journal of International Medical Research
IS - 5
ER -