MRI-SWI as a Predictor of Functional Outcome in Acute Ischemic Stroke

Stroke is the second leading cause of death in Taiwan. The morbidity and mortality of stroke is also very high worldwide. In the United States, about one third of 800,000 stoke patients became disabled; while in Taiwan, 13,000 out of 68,000 stroke patients died each year.

Diffusion tensor imaging (DTI) characterizes the three-dimensional distribution of water diffusion, which is highly anisotropic. Previous studies utilized DTI derived mean diffusivity (MD) and fractional anisotropy (FA) have found correlation between pathological changes of white matter and prognosis of stroke. However, the result was not specific due to the reason that any change at either axon or myelin sheath resulted in FA reduction. DTI, on the other hand, differentiate morphological change at axon and myelin sheath with axial and radial diffusivity, respectively. With this data, we hypothesized that the prognosis might be more relevant to pathological change with axon post-stroke when compare to Diffusion-Weighted imaging (DWI)/Apparent Diffusion Coefficient (ADC).

Susceptibility-weighted imaging (SWI) is a newer technique which use fully velocity compensation gradient echo sequence to receive magnitude and phase imaging. SWI can be used to detect early phase bleed, intra-arterial thrombus, cerebral venous thrombosis, thus evaluate the prognosis of patients by detect leptomeningeal collateral circulation and intravascular deoxygenation changes. We hypothesized that the prognosis is better in post-stroke patients with preserved leptomeningeal collateral circulation and venous circulation of large blood vessel. Therefore, we conduct the study to use DTI derived axial diffusivity and SWI to evaluate the severity and to predict the functional outcome in acute ischemic stroke patient.

Inclusion criteria

• Age greater than 20 years
• Patients with acute pathological changes in CNS within 7 days admitted from outpatient, ER, or inpatient department
• Confirmed diagnosis of acute ischemic stroke by clinical testings and CT scan performed by a neurologist
• Signed informed consent from patient

Exclusion criteria

• Any person with pacemaker, metal implant, claustrophobia, or any other contraindication for MR examination
• Any person with epilepsy, brain hematomas, brain tumor, or any neurological disease confirmed by CT scan
• Any other clinical condition which, in the opinion of the principal investigator, would not be suitable for this study