Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) is a critical condition that still requires early detection, precise staging & comprehensive evaluation of its secondary effects on the cerebral tissue to better guide the clinical & surgical manipulation by using Up-to-date MRI techniques.
Objectives: aiming to evaluate the additional benefits of incorporating susceptibility & diffusion-weighted imaging (SWI & DWI) alongside conventional T1, T2 WIs in identifying recent ICH by verifying the degree of correlation in detection and stage evaluation, focusing on the hyper-acute and acute phases, thereby enhancing ICH diagnosis confidence using MRI.

Patients and methods: a clinically suspected 50-patients to have recent ICH within three days of symptom-onset referred to the radiology department at Al-Hussein Hospital for an urgent CT scan, followed by a comprehensive MRI evaluation that included axial T1, T2, Diffusion, and ADC-map & SWI sequences to better assess the hematoma's condition. The study was conducted from March-2022 to June-2023.

Results: Our investigation revealed that SWI exhibits higher sensitivity compared to DWI, while combined both techniques enhances sensitivity and accuracy for early ICH detection more effectively than using DWI or SWI in isolation. Additionally, there is no significant statistical disparity in positive predictive value among the three methods. SWI independently proves advantageous in identifying CAA micro bleeds and small cortical hematomas, areas where CT's capabilities usually surpassed.

Conclusion: The combination of SWI & DWI showed similar detection rates to CT scans, but had a greater diagnostic value compared to SWI alone & DWI alone for early identification of ICH.