| Objective:To investigate the role of susceptibility weighted imaging (SWI) in diagnosis of vascular malformations, infarction, spontaneous brain hemorrhage and trauma, brain tumors and abnormal mineral matter deposition diseases.Materials and methods:1. Materials: 169 patients, include vascular abnormal (45 cases of vascular malformation and 7 cases of moya-moya disease), infarction (40 cases), hemorrhage (35 cases of spontaneous brain hemorrhage and trauma), brain tumors (35 cases), tuberous sclerosis (2 cases) and abnormal mineral matter deposition diseases (5 cases), underwent both standard (3T) MRI (T1WI, T2WI) and SWI. In addition, 6 cases of vascular malformation were performed with contrast enhanced T1WI (CE-T1), 13 cases with MRA examination, 8 cases with DSA examination. 31 cases of acute infarction were scanned with DWI scan. All cases of hyperacute brain hemorrhage took CT scan. 27 cases of brain tumor underwent CE-T1, 18 cases of them underwent contrast enhanced SWI (CE-SWI) scan, and 9 cases of them were scanned with CT. 2. Method: Analyze the ability of SWI images to show diseases, and compare them with conventional MR sequences. In those cases of spontaneous brain hemorrhage and trauma, compare the detective rate of CT, T2WI, and SWI. In those cases of tumors, SWI images were compared on a slice-by-slice basis with each of the comparison sequences (T1, T2, CE-T1 or CE-SWI, as available per case). For each sequence the following categories were analyzed: lesion visibility, lesion boundaries, blood products, venous vasculature, internal lesion architecture, edema and image quality. Each category was assigned a numerical value according to a scale ranging from 0 to 3. We compared CE-T1 with CE-SWI in the aspect that tumor character visualization. The correlation between the SWI findings and the pathology report data was analyzed.Result:1. Vascular malformation. In 52 cases of vascular abnormal, SWI clearly showed not only the size and number of diseases, but abnormal veins, including 45 cases of vascular malformation and 7 cases of moya-moya disease. In the cases of vascular malformation, there were 29 cases of cavernous angioma, 5 cases had multiple foci, so the total of foci was 95. SWI showed more 46 and 41 foci than T1WI and T2WI, respectively, and showed larger focus size than them. 13 cases of AVM had 15 foci in total, SWI showed more 2 than T2WI. In 3 cases of venous malformation, SWI showed abnormal veins were low signal. In 7 cases of Moya-Moya disease, SWI showed vein proliferation and morphous.2. Infarction. In 22 cases of infarction with hemorrhage, SWI clearly showed low signal of the focus. 5 cases (22.7%) had multiple micro hemorrhages in brain parenchyma outside the leisure. In 2 cases, near disease region there were malformation veins of low signal in SWI image. In 18 cases of infarction without hemorrhage, SWI showed the lesions were slightly high or media.3. Hemorrhage (Spontaneous brain hemorrhage and trauma). In our research, SWI could display hyperacute hemorrhage as early as 45 minutes. In 8 cases of hyperacute brain hemorrhage, CT detection rate was 87.5%, SWI's was 100%, T1WI and T2WI's were 37.5%. In 11 cases of acute hemorrhage, CT and SWIs' detective rate were both 100%, T1WI and T2WIs'were 81.8% and 90.9%, respectively. In 16 cases of subacute and chronic hemorrhage, SWI, T1WI and T2WI's detective rate were 100%. So, in cases of hyperacute hemorrhage, SWI was more sensitive to hemorrhage than T2WI.4. Brain tumors. 35 cases had 46 focuses in total. In SWI, 37 (80.4%) of them were low signal, 8 (17.4%) were media signal, 1 (2.2%) were slight high signal, edema were high signal. 27 cases underwent CE-T1 examination, 18 of them underwent SWI postcontrast. In CE-SWI images, 16 (88.9%) tumors appeared slight high signal, 2 (11.1%) tumors appeared media signal. SWI and CE-SWI displayed better images of hemorrhage and vascular architecture in tumors than conventional MRI and postcontrast T1WI. In 14 cases, CE-SWI displayed better images of blood product than CE-T1, and in 11 cases, CE-SWI displayed better images of vascular architecture than CE-T1. In 24 cases (68.6%), pathology reports described hemorrhage, vascular architecture, calcification in tumors, and SWI results were consistent with them.5. Others. 2 cases of tuberous sclerosis and 5 cases of abnormal metabolism disease, SWI definitely showed location and size. In cases of tuberous sclerosis, SWI showed more 1 focus than T2WI.Conclusion:SWI is a new MRI sequence which is extremely sensitive to hemorrhage and veins. Our data demonstrate that SWI is a clinically useful tool for diagnosing brain disease, can display hemorrhage and vascular better than conventional sequences. In cases of vascular malformation and hemorrhage, SWI can show focus missed by T1WI and T2WI. In brain tumors, SWI and CE-SWI can provide more details so that it is useful to decide whether the tumor is malignancy or benign. In addition, SWI can describe iron and calcification deposition in the brain. We believe that with the development of MRI software, SWI has a promised future, and will change the idea about choosing vascular disease examination methods.
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