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NEUROIMAGE
Year : 2011  |  Volume : 59  |  Issue : 6  |  Page : 943

Direct visualization of thrombus load in MCA in acute stroke on susceptibility weighted imaging


1 Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
2 Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

Date of Submission02-Jan-2012
Date of Decision02-Jan-2012
Date of Acceptance02-Jan-2012
Date of Web Publication2-Jan-2012

Correspondence Address:
Bejoy Thomas
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala
India
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DOI: 10.4103/0028-3886.91399

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How to cite this article:
Thomas B, Lingegowda D, Kesavadas C, Sylaja P N. Direct visualization of thrombus load in MCA in acute stroke on susceptibility weighted imaging. Neurol India 2011;59:943

How to cite this URL:
Thomas B, Lingegowda D, Kesavadas C, Sylaja P N. Direct visualization of thrombus load in MCA in acute stroke on susceptibility weighted imaging. Neurol India [serial online] 2011 [cited 2014 Sep 20];59:943. Available from: http://www.neurologyindia.com/text.asp?2011/59/6/943/91399


"MCA Susceptibility sign" has been proved to be useful in detecting thrombus in the proximal middle cerebral artery (MCA) in acute ischemic stroke on gradient recalled echo imaging (GRE). [1] Recently, susceptibility weighted imaging (SWI) has been shown to be an excellent sequence in imaging of acute stroke by detecting areas of increased susceptibility. [2] We report preliminary findings on the usefulness of SWI magnitude imaging in directly visualizing the thrombus load in the MCA, in acute ischemic stroke. Three illustrative cases of varying degrees of ischemic changes and thrombus load in the left MCA are summarized in [Figure 1]. SWI was found to be much superior in directly visualizing the thrombus load, compared to the source and MIP images of Time of Flight (TOF) MR angiography. SWI magnitude image can demonstrate the normal MCA with bright signals within, which could be followed up to M2 and M3 branches, as it uses a 3D GRE sequence with very thin (2 mm) contiguous slices. The thrombus in these branches will be seen as dark signals with evidence of "blooming." Use of SWI, especially with the magnitude images, will help in visualizing the location, extent, and severity of acute MCA thrombus/embolus. Further prospective studies are required to validate the therapeutic implications of this finding.
Figure 1: (a1, b1, c1) DWI in three different patients with acute ischemic left MCA territory stroke with varying (decreasing) clinical severity (thick arrows). (a2, b2, c2) Corresponding axial time of flight angiography showing left MCA involvement of varying degrees (white arrows); however, it should be noted that the degree of occlusion or thrombus load is not very evident on this. (a3, b3, c3) Respective SWI magnitude images showing the decreasing thrombus load very clearly as hypo-intensity with "blooming" within the left MCA (black arrows). (a3) Shows thrombus in entire proximal left MCA, (b3) shows thrombus in M2 upper division and (c3) shows in one of the distal M3 branches

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1.Rovira A, Orellana P, Alvarez-Sabín J, Arenillas JF, Aymerich X, Grivé E, et al. Hyperacute ischemic stroke: Middle cerebral artery susceptibility sign at echo-planar gradient-echo MR imaging. Radiology 2004;232:466-73.   Back to cited text no. 1
    
2.Santhosh K, Kesavadas C, Thomas B, Gupta AK, Thamburaj K, Kapilamoorthy TR. Susceptibility weighted imaging: A new tool in magnetic resonance imaging of stroke. Clin Radio l2009;64:74-83.  Back to cited text no. 2
    


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