Detection of Microhemorrhages in Cerebral Amyloid Angiopathy by Susceptibility Weighted MR Imaging – An Observational Study

Abstract

Introduction: Cerebral amyloid angiopathy (CAA) is a cause for approximately 10-20% of spontaneous intracerebral haemorrhage in elderly population. Susceptibility weighted imaging (SW1) is a new imaging method is clinically useful for evaluating the presence of chronic blood products in the brain, especially clinically silent microbleeds associated with cerebral amyloid angiopathy. Aim of this study was to determine the advantages of Susceptibility weighted imaging (SW1) over conventional gradient echo (GRE) technique in a probable diagnosis of Cerebral amyloid angiopathy. Material and Methods: All patients more than 55 yrs presented with neurological signs and symptoms referred for neuroimaging, were subjected to image with MRI using T1W, T2W, FLAIR. AXIAL 2D MERGE, Diffusion weighted imaging (DWI) including apparent diffusion coefficient (ADC) and Susceptibility weighted imaging (SWI). Those cases having multiple macro and micro haemorrhages involving cortical and sub cortical region detected by either gradient or SWI included in the study. Results: Sudden onset of neurological deficit was the most common symptom which accounted for 37% of cases. Cortical and sub cortical regions are most commonly involved sites. On comparison between gradient and SWI, 11 cases having micro hemorrgages detected only by SWI and absent in gradient. Conclusion: GE-T2* MR imaging is currently the " standard" for identifying microhemorrhages and diagnosing cerebral amyloid angiopathy based on number and distribution of micro haemorrhages. SW1 identified many more microhemorrhages than conventional T2* weighted GE magnitude technique and may lead to earlier diagnosis of patients with CAA.