Susceptibility weighted imaging: a new tool in magnetic resonance imaging of stroke

Susceptibility weighted imaging (SWI) is a magnetic resonance (MR) technique that is exquisitely sensitive to paramagnetic substances, such as deoxygenated blood, blood products, iron, and calcium. This sequence allows detection of haemorrhage as early as 6h and can reliably detect acute intracerebral parenchymal, as well as subarachnoid haemorrhage. It detects early haemorrhagic transformation within an infarct and provides insight into the cerebral haemodynamics following stroke. It helps in the diagnosis of cerebral venous thrombosis. It also has applications in the work-up of stroke patients. The sequence helps in detecting microbleeds in various conditions, such as vasculitis, cerebral autosomal dominant arteriopathy, subacute infarcts and leucoencephalopathy (CADASIL), amyloid angiopathy, and Binswanger's disease. The sequence also aids in the diagnosis of vascular malformations and perinatal cerebrovascular injuries. This review briefly illustrates the utility of this MR technique in various aspects of stroke diagnosis and management.