.: ORİJİNAL ARAŞTIRMA
Additional Value of Susceptibility Weighted Imaging in the Evaluation of Acute Ischemic Stroke Patients
Akut İskemik İnmeli Hastaların Değerlendirilmesinde Duyarlılık Ağırlıklı Görüntülemenin İlave Değeri
Turkiye Klinikleri J Med Sci. 2020;40(1):59-67
doi: 10.5336/medsci.2019-71071
Makale Dili: EN
Tam Metin
ABSTRACT
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.
Keywords: Ischemia; magnetic resonance imaging; stroke; susceptibility weighted imaging
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.
Keywords: Ischemia; magnetic resonance imaging; stroke; susceptibility weighted imaging
ÖZET
Amaç: Bu çalışmadaki amacımız, duyarlılık ağırlıklı görüntüleme (DAG)'nin akut iskemik inmeli hastaların değerlendirilmesinde rutin manyetik rezonans görüntüleme (MRG)'ye ilave fayda sağlayan bir yöntem olduğunu kanıtlamaktır. Gereç ve Yöntemler: Prospektif özellikteki çalışmamızda akut iskemik inme ile prezante olan ve tanıları klinik bulgular ve diffüzyon ağırlıklı görüntüleme (DifAG)'ye dayanan 65 hastayı inceledik. Tüm hastalar inme başlangıcını takip eden 24 saat içerisinde beyin bilgisayarlı tomografi (BT) ve beyin MRG'ye gönderildi. Bulgular: DAG ile 65 hastanın 12 tanesinde (%18) daha sonra BT veya rutin MRG sekanslarında görülemeyen makrohemoraji veya peteşial mikrohemoraji formundaki kanamaları saptamayı başardık. Bu 12 hastanın 6 tanesi (%50) makrohemoraji ve kalan 6 tanesi ise (%50) peteşial mikrohemorajiye sahipti. DAG, diğer görüntüleme modaliteleri ile saptanması mümkün olmayacak tüm mikrohemorajileri (%100) saptama yeteneği gösterdi. Belirgin damar işareti, 65 hastanın 53 (%82)'ünde akut iskemik beyin bölgesi yakınında gösterildi. Hastaların 31 (%48)'inde BT'de hiperdens arter işareti ve 21 (%32)'inde 'fluid attenuated inversion recovery (FLAIR)' sekansında hiperintens arter işareti saptandı. Bununla birlikte, DAG sekansında 65 hastanın 55 tanesinde (%85) farklı majör intrakraniyal arter lokasyonlarında duyarlılık damar işareti mevcuttu. Sonuç: DAG'nin akut iskemik inmeli hastaların değerlendirilmesinde, diğer görüntüleme modaliteleri ile saptanması mümkün olamayacak çok değerli ilave bilgilerin elde edilmesini sağlayan bir yöntem olduğu kanıtlanmıştır.
Anahtar Kelimeler: İskemi; manyetik rezonans görüntüleme; inme; duyarlılık ağırlıklı görüntüleme
Amaç: Bu çalışmadaki amacımız, duyarlılık ağırlıklı görüntüleme (DAG)'nin akut iskemik inmeli hastaların değerlendirilmesinde rutin manyetik rezonans görüntüleme (MRG)'ye ilave fayda sağlayan bir yöntem olduğunu kanıtlamaktır. Gereç ve Yöntemler: Prospektif özellikteki çalışmamızda akut iskemik inme ile prezante olan ve tanıları klinik bulgular ve diffüzyon ağırlıklı görüntüleme (DifAG)'ye dayanan 65 hastayı inceledik. Tüm hastalar inme başlangıcını takip eden 24 saat içerisinde beyin bilgisayarlı tomografi (BT) ve beyin MRG'ye gönderildi. Bulgular: DAG ile 65 hastanın 12 tanesinde (%18) daha sonra BT veya rutin MRG sekanslarında görülemeyen makrohemoraji veya peteşial mikrohemoraji formundaki kanamaları saptamayı başardık. Bu 12 hastanın 6 tanesi (%50) makrohemoraji ve kalan 6 tanesi ise (%50) peteşial mikrohemorajiye sahipti. DAG, diğer görüntüleme modaliteleri ile saptanması mümkün olmayacak tüm mikrohemorajileri (%100) saptama yeteneği gösterdi. Belirgin damar işareti, 65 hastanın 53 (%82)'ünde akut iskemik beyin bölgesi yakınında gösterildi. Hastaların 31 (%48)'inde BT'de hiperdens arter işareti ve 21 (%32)'inde 'fluid attenuated inversion recovery (FLAIR)' sekansında hiperintens arter işareti saptandı. Bununla birlikte, DAG sekansında 65 hastanın 55 tanesinde (%85) farklı majör intrakraniyal arter lokasyonlarında duyarlılık damar işareti mevcuttu. Sonuç: DAG'nin akut iskemik inmeli hastaların değerlendirilmesinde, diğer görüntüleme modaliteleri ile saptanması mümkün olamayacak çok değerli ilave bilgilerin elde edilmesini sağlayan bir yöntem olduğu kanıtlanmıştır.
Anahtar Kelimeler: İskemi; manyetik rezonans görüntüleme; inme; duyarlılık ağırlıklı görüntüleme
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