MR Susceptibility SWI
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This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
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As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
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Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
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Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0380-MR Susceptibility SWI
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CA0380-MR Susceptibility SWI
Case ReportHistory
Exam
Prior Study
1. Acute hyperdense thrombus in the distal basilar artery (last 3mm’s), and of the basilar apex.
2. No focal reduced CT density within the venocapillary pool is evident to confirm completed stroke in the rostral cerebellum, rostral brain stem, nor occipital poles.
MR Diffusion
1. Multicentric embolic-type strokes are present including the PICA perfusion zones in the caudal cerebellar hemispheres, the distal basilar perforators to the Rt. cerebral peduncle, the basilar tip perforators to the mesial thalamus, the Rt. posterior mesial choroidal artery perforators to the dorsal Rt. thalamus, and the P4 branches to both occipital polar areas.
MR Flair
Multicentric hyperacute to early acute (6 hours to 1 day) thromboembolic infarctions are evident involving: the distal PICA branches in both cerebellar hemispheres, the distal basilar perforator to the Rt. cerebral peduncle, the basilar tip perforators to the mesial thalamus, the Rt. posterior mesial choroidal perforators to the dorsal Rt. thalamus, a mesial P4 larger infarction right mesial occipital lobe, and finally, multiple small very distal the P4 branches to both occipital poles.
Findings
MR susceptibility
There is SWI susceptibility blooming artifact in the site of the distal basilar thrombus.
There is a reduction in the number of mesial cortical veins on the right compared to the left within the stroke in the right mesial occipital lobe. There is evidence of abnormal parenchymal signal within the right mesial occipital stroke-zone. There is SWI positive low-grade blooming artifact within the venocapillary blood pool within the stroke-zone. This likely represents thrombus forming in the capillary venous plexus, which usually proceeds to sequestered infarction. This is type of ischemic stroke is the most severe type of dense ischemic core.
There is no evidence of hemorrhagic conversion.
Impression
2. There is reduced venous egress from the Rt. mesial occipital infarction site, plus evidence of intraluminal venous stasis/thrombosis. These are findings of early sequestered stroke.
3. There is no evidence of hemorrhagic conversion.
Recommendations
A video discussion of all CT, CTA, and MR elements is available, which reviews all the pertinent findings and summarizes their importance in this clinical case.
