Original Article: To Evaluate The Role of Susceptibility Weighted Imaging (SWI) in Adult Cerebral Hemorrhage and Its Comparison with Gradient Echo (GRE) Sequence

Abstract Introduction: Cerebral hemorrhage poses significant challenges in therapeutic management due to its potential for severe neurological consequences. Advanced imaging techniques like Susceptibility Weighted Imaging (SWI) and Gradient Echo (GRE) sequences have become vital for accurate diagnostics. SWI has garnered interest for its sensitivity to blood products, enabling enhanced visualization of hemorrhagic lesions, especially cerebral microbleeds (CMBs). However, its utility compared to GRE in detecting hemorrhages needs further exploration. Objective: This study evaluates the diagnostic efficacy of SWI in adult cerebral hemorrhage, comparing its performance with the widely-used GRE sequence. Methods: Conducted as a cross-sectional study at Gandhi Medical College and Hamidia Hospital, Bhopal, India, from September 2022 to December 2023, this research included adult patients with suspected intracranial hemorrhage, stroke, or conditions like cerebral amyloid angiopathy. Data were gathered on hemorrhage detection rates, area measurements, and lesion specificity across SWI and GRE, with statistical comparisons performed on these metrics. Results: The analysis revealed that SWI identified a significantly higher number of hemorrhages (mean: 3.30 vs. GRE: 2.74, p < 0.001) and a larger mean hemorrhage area (654.82 mm² vs. GRE: 575.03 mm², p = 0.001). SWI also demonstrated greater sensitivity in detecting CMBs and hemorrhagic lesions in complex brain regions, including the basal ganglia and brain stem. Specific hemorrhage types, such as infarcts with hemorrhagic transformation and intraparenchymal bleeds, were more accurately visualized on SWI than GRE. Conclusion: SWI outperforms GRE in detecting cerebral hemorrhages, particularly in identifying more lesions and larger areas, making it a valuable tool in neuroimaging. Its enhanced sensitivity suggests SWI could improve diagnostic accuracy, guiding better clinical management of cerebral hemorrhage cases.