Should Susceptibility‑weighted Imaging be Included in the Protocol for Evaluation of Acute Ischemic Stroke Patients?

Context: Stroke is one of the leading causes of death globally and is a major cause of long‑term disability. Aims of Study: (1) To identify hemorrhagic foci in patients with acute ischemic stroke by susceptibility‑weighted imaging (SWI). (2) To compare the detection of hemorrhagic foci in patients with acute ischemic stroke by SWI versus conventional magnetic resonance imaging (MRI) (T1‑weighted, T2‑weighted, and fluid‑attenuated inversion recovery [FLAIR]). Materials and Methods: Two‑hundred and fifty patients, who clinically presented with neurological deficit, were evaluated using 1.5 Tesla MRI scanner from October 2011 to September 2013 with the above sequences. Detection of hemorrhage in acute infarct was evaluated and compared. Results: Of 250 patients evaluated in this study, 232 cases were arterial infarcts and 18 cases were venous infarcts. Hemorrhage was detected in 86 (34.4%) patients, of which 68 cases were from arterial infarcts and 18 were from venous infarcts. SWI was significantly sensitive and specific (P < 0.004) for the detection of hemorrhage in acute infarct compared to T1‑weighted, T2‑weighted, and FLAIR. Conclusion: SWI is a very sensitive sequence for the detection of hemorrhage in acute stroke patients. Therefore, its use is recommended in the protocol for evaluation of these patients.