MR susceptibility sign of the middle cerebral artery in imaging of acute stroke

To evaluate the accuracy of echo-planar T2-weighted, compared to MRA and FLAIR in the detection of acute middle cerebral artery [MCA] thrombotic occlusion. 47 consecutive patients with acute stroke involving the MCA territory underwent MR imaging within 2 to 76 hours after clinical onset. MR examination included echo-planar T2-weighted-, FLAIR, diffusion-weighted-imaging [DWI] and MR-angiography [MRA]. The susceptibility sign on echoplanar T2-weighted images, which is indicative of acute thrombotic occlusion involving the MCA, was assessed and compared to findings on MRA and axial FLAIR in all patients and to CT in 23 patients. National Institutes of Health Stroke Scale [NIHSS] score, which is a clinical scale assessment, was used for evaluating the neurological status of patients. Fourty seven [47] patients [29 males; age range 11-86years [mean: 58.3 +/- 14.7 yrs] and 18 females; age range 35-83 years [mean: 59.4 +/- 12.7 yrs] with acute territorial MCA infarcts were included in this study. Out of these 47 patients, 10 had hyperacute MCA infarction [scanned 2-6 hours after ictus], 7 of those patients presented with very severe stroke [NIHSS score 21 or more] and 3 patients with severe stroke [NIHSS score 15-20]. Thirty seven [37] patients were studied within 76 hours from ictus [acute to early subacute]. Among this group and according to NIHSS score, 5 patients had mild to moderate stroke, 16 patients severe stroke; and 13 patients had very severe stroke. One patient who had very severe stroke with NIHSS score of 22, died. She had left MCA occlusion, presented 4 hours within onset of right hemiplegia and had a history of DM, HTN and COPD. Presence of the susceptibility sign on T2 WI proximal to the MCA bifurcation provides fast and accurate detection of acute proximal MCA thrombotic occlusion. It is considered a warning sign for rapid and efficient intervention for stroke treatment, including thrombolysis and can be used for follow up of thrombus evolution