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Acute and subacute liver-related hemorrhage: MRI findings
N C Balci1, R C Semelka, T C Noone
1Department of Radiology, University of North Carolina at Chapel Hill, 27599-7510, USA.
Abstract:
We retrospectively reviewed the MR studies on all patients with liver-related fluid collections compatible with acute or early subacute hemorrhage, who underwent MR imaging at our center between June 1994 and January 1998. All patients had a clinical history of an underlying liver lesion or injury with a duration of symptomatology of less than 5 days. In three patients with only 2-3 days of symptoms, the liver-related hemorrhagic fluid was hypointense on T1-weighted images and markedly hypointense on T2-weighted images relative to liver, consistent with intracellular deoxyhemoglobin. The fluid was relatively homogeneous in signal intensity. In three patients with 3-5 days of symptoms, the majority of liver-related fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images relative to liver, consistent with intracellular methemoglobin. Three of these latter four patients also had fluid collections of varying T1-and T2-weighted signal intensity consistent with blood breakdown products of varying ages. Clinical findings matched the MR findings of acute/early subacute blood in all cases. Our results describe the findings of acute and early subacute liver hemorrhage. The most helpful MR feature of bleeding of recent origin is very low signal intensity of the fluid on T2-weighted imaging.
Insights
Magnetic resonance (MR) imaging can detect acute liver hemorrhage. Very low signal intensity on T2-weighted images is a key indicator of recent bleeding in the liver.
Area of Science:
- Radiology
- Medical Imaging
- Hepatology
Background:
- Liver-related fluid collections can indicate hemorrhage, requiring accurate diagnostic methods.
- Differentiating acute from subacute bleeding is crucial for patient management.
Purpose of the Study:
- To describe the magnetic resonance (MR) imaging findings of acute and early subacute liver hemorrhage.
- To identify key MR features indicative of recent bleeding in liver-related fluid collections.
Main Methods:
- Retrospective review of MR studies in patients with liver-related fluid collections suggestive of hemorrhage.
- Analysis of MR imaging characteristics (T1- and T2-weighted images) in relation to symptom duration (2-5 days).
- Correlation of MR findings with clinical history and presentation.
Main Results:
- In early stages (2-3 days), hemorrhagic fluid appeared hypointense on T1 and markedly hypointense on T2-weighted images.
- In slightly later stages (3-5 days), fluid was hyperintense on T1 and hypointense on T2-weighted images, consistent with methemoglobin.
- The presence of mixed signal intensities indicated blood breakdown products of varying ages.
- Clinical findings consistently correlated with MR findings of acute/early subacute blood.
Conclusions:
- MR imaging effectively characterizes acute and early subacute liver hemorrhage.
- Very low signal intensity on T2-weighted imaging is the most significant MR feature for identifying recent liver bleeding.