Comparison of Susceptibility Weighted Imaging and Time of Flight MR Angiography in the Detection of Intra-Arterial Thrombus in Acute Ischemic Stroke Patients

  • Ahmet Mesrur Halefoglu Mail Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Ischemia, Magnetic resonance imaging, Susceptibility weighted imaging


Susceptibility weighted imaging (SWI) and time of flight (TOF) magnetic resonance angiography (MRA) techniques can be used in the detection of major vessel occlusion. Our aim was to compare diagnostic accuracies of SWI and TOF MRA in the detection of arterial thrombotic occlusion in acute ischemic stroke patients. In this prospective study, we included 63 consecutive patients presenting with acute ischemic stroke symptoms in whom diagnoses were based on clinical findings and diffusion-weighted imaging (DWI) studies performed within 24 hours of the onset of symptoms. The susceptibility vessel sign (SVS) and TOF MRA findings of the patients were statistically evaluated in terms of detecting acute thrombotic arterial occlusion. In  50 out of 63 patients, SVS on SWI in major intracranial artery territories and a corresponding occlusion or severe stenosis of vessels on TOF MRA were detected with a concordance. In 5 patients, although the SVS was available, TOF MRA did not reveal any occlusion or stenosis in the corresponding artery territory. On the contrary, 3 patients showed stenosis or occlusion on TOF MRA in whom SVS was negative. Finally, in the remaining 5 patients with acute infarct, neither SVS on SWI nor occlusion or stenosis on TOF MRA were displayed. SVS on SWI yielded slightly higher sensitivity than TOF MRA  in detecting intra-arterial thrombus in acute ischemic stroke patients. Although SWI and TOF MRA have similar diagnostic accuracies in the diagnosis of acute thrombotic occlusion in stroke patients, SWI has been found slightly superior to TOF MRA.


1- Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility weighted imaging : Technical aspects and clinical applications, Part 2. AJNR Am J Neuroradiol 2009 ; 30 : 232-52.
2- Haacke EM, Mittal S, Wu Z, Neelavalli J, Cheng YCN. Susceptibility weighted imaging : Technical aspects and clinical applications, Part 1. AJNR Am J Neuroradiol 2009 ; 30 : 19-30.
3- Rovira A, Orellana P, Alvarez-Sabin J, Arenillas JF, Aymerich X, Grive E, et al. Hyperacute ischemic stroke : Middle cerebral artery susceptibility sign at echo planar gradient-echo MR imaging. Radiology 2004 ; 232 : 466-73.
4- Hermier H, Nighoghossian N. Contribution of susceptibility-weighted imaging to acute stroke assessment. Stroke 2004 ; 35 : 1989-94.
5- Chalela JA, Haymore JB, Ezzeddine MA, Davis LA, Warach S. The hypointense MCA sign. Neurology 2002 ; 58 : 1470.
6- Huang P, Chen CH, Lin WC, Lin RT, Khor GT, Liu CK. Clinical applications of susceptibility weighted imaging in patients with major stroke. J Neurol 2012 ; 259 : 1426-32.
7- Lingegowda D, Thomas B, Vaghela V, Hingwala DR, Kesavadas C. Sylaja PN. Susceptibility sign on susceptibility- weighted imaging in acute ischemic stroke. Neurology India 2012 ; 60 : 160-4.
8- Naggara O, Raymond J, Ayllon MD, Al-Shareef F, Touze E, Chenoufi M, et al. T 2 * “ Susceptibility vessel sign ” demonstrates clot location and length in acute ischemic stroke. PLoS One 2013 ; 8 ( 10 ) : e76727.
9- Ishimaru H, Ochi M, Morikawa M, Takahata H, Matsuoka Y, Koshiishi T, et al. Accuracy of pre- and postcontrast 3D time-of-flight MR angiography in patients with acute ischemic stroke : correlation with catheter angiography. AJNR Am J Neuroradiol 2007 ; 28 : 923-6.
10- Radbruch A, Mucke J, Schweser F, Deistung A, Ringleb PA, Ziener CH, et al. Comparison of susceptibility weighted imaging and TOF-angiography for the detection of acute thrombi in acute stroke. PLoS One 2013 ; 8 (5) : e63459.
11- Ladd ME. High-field-strength magnetic resonance : potential and limits. Top Magn Reson Imaging 2007 ; 18 : 139-52.
12- Cho KH, Kim JS, Kwon SU, Cho AH, Kang DW. Significance of susceptibility sign on T 2 * - weighted gradient echo imaging for identification of stroke subtypes. Stroke 2005 ; 36 : 2379-83.
13- Liebeskind DS, Sanossian N, Yong WH, Starkman S, Tsang MP, Moya AL, et al. CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke 2011 ; 42 : 1237-43.
14- Heiserman JE, Drayer BP, Keller PJ, Fram EK. Intracranial vascular stenosis and occlusion : evaluation with three-dimensional time-of-flight MR angiography. Radiology 1992 ; 185 : 667-73.
How to Cite
Halefoglu A. Comparison of Susceptibility Weighted Imaging and Time of Flight MR Angiography in the Detection of Intra-Arterial Thrombus in Acute Ischemic Stroke Patients. Acta Med Iran. 57(12):698-702.