Susceptibility Weighted MRI and Cerebrovascular Disorders

Fony Y Tsai, Hung-Wen Kao, Yu-Kun Tsui,

Anton H Hasso and Fred Greensite,

UC Irvine Medical Center, Orange, Ca

Method and Materials• All patients underwent MRI with 12 channel head coil in

1.5T(Avanto,Siemens,Erlangen,Germany)and 3T(Trio,Siemens,Erlangen,Germany).

• Parameters of SWI:• 1.5T:TR:49ms,TE40msFlip angle15,bandwidth

80kHz,slice thickness 2mm,64slices in a single slab,matrix size177x256,acquistion time 3min&59s with iPAT factor-2.

• 3T:Tr27ms,TE29ms,Flip angle15,bandwidth 120kHz,slice thickness 2mm,64slices in a single slab, matrix size182x256,acquisition time 3min&22s with iPAT factor-2

• All images obtained in axial plane• The phase,magnitude,SWI and minIP images were

uploaded to PACS system.

Method and Materials• Retrospectively reviewed 903 patients from July 2008 to July

2010.• Among those 595 patients who had varied cerebrovascular

diseases were reported in our previous study excluded• 299 ischemic stroke,7 cardiac arrested with cessation of

cerebral circulation and 2 chronic venous hypertension• Gender ratio: male to female:162 to 146• Age: mean ae of all patients:65.4 and mean female is 69.1 and

mean male age is 62.6. • 118 patients had complete pre and post-treatment CT,MRI

with SWI.• 32 of 118 were excluded from motions and artifacts• 86 stroke patients and 9 others were evaluated in this series.

Result of Stroke Patients• 4 patients: vertebral arterial disease• 7 patients: posterior cerebral arterial occlusion• 11 patients: internal carotid arterial thrombosis• 21 patients: diffused atherosclerosis• 2 patients: anterior cerebral arterial disease• 42 patients: middle cerebral arterial thrombosis• 23 patients had negative on SWI from small infarction

on DWI• 56 patients had early sign of infarction on CT,CT finding

did not accord with SWI• 63 patients had varied degree of abnormal hypointense

vessel on SWI.

Cases Presentations

Case 128/male acute left side weakness,

history of chronic headache without definite etiology

CT,T1&DWI

Flair&contrast

Venous Pressure Gradient It was double SSS>SS Venous hypertension

Case Presentation

Case 252/F acute confusion with stomach Flu,

Suddenly lapsed to coma, upon arrival to UCI from transferring,

unresponsive.

Initial CT

arrival CT

Case Presentation

Case 3 55/M presented with acute left side

weakness history of hypertension and hyperlipdemia

PWI/MTT

SWI

Case Presentation

Case 473/F presented with acute left side

weakness with Aggrenox,history of TIA and hypertension

Initial MRI DWI/Flair

Flair,PWI/MTT

PWI/ dfV

MRA and Cerebral Angiogram

Follow-up MRA &DWI

Follow-up Flair

Case Presentation

Case 543/M presented with expressive aphasia, right homonymous hemianopsia and right side weakness, worse on upper extremity.

Case Presentaion

Case 656/M sudden lost his right eye vision

and left side weakness,History of hypertension and recent

Myocardial Infarction

Summary and Conclusion

• Presence of deoxygenated hyopintense vessels may indicated slow/stasis or thrombosis

• It may be used to detect venous hyperetension,braindeath,and poor prognosis of infarction due to poor intrinsic collaterals

Thank you for attention

Appreciate the opportunity to share our experience