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[The "heme"-sequence (T2*-weighted gradient echo magnetic resonance tomography). Value in differential spontaneous
H R Siebner1, H Gräflin von Einsiedel, T Wilhelm
1Neurologische Klinik und Poliklinik der Technischen Universität München.
Abstract:
In four patients presenting with acute non-traumatic intracerebral or intraspinal hemorrhage, T2*-weighted gradient-echo MRI showed numerous residual hemosiderin deposits due to old intracerebral hemorrhages that were missed on initial CT and spin-echo MRI. The demonstration of additional chronic bleedings and their anatomical distribution provided important diagnostic information. In a hypertensive patient, the hemosiderin deposits were most pronounced within deep brain structures suggesting hypertensive cerebral microangiopathy. In a second patient, the cortico-subcortical distribution of the hemorrhages was typical of cerebral amyloid angiopathy. In a third patient, the diffuse distribution including spinal bleeding, the marked calcification, and the characteristic appearance on spin-echo MRI were consistent with multiple cavernomas. In another patient with cerebral and spinal hemorrhage, T2*-weighted gradient-echo MRI revealed new subclinical hemorrhages during follow-up. Based on these findings, we recommend that T2*-weighted gradient-echo MRI of the brain should be performed in all patients with acute intracranial and spinal bleedings.
Insights
T2*-weighted gradient-echo MRI detects old hemorrhages missed by CT and spin-echo MRI. This technique aids in diagnosing various conditions like hypertensive microangiopathy and cerebral amyloid angiopathy.
Area of Science:
- Neuroradiology
- Neuroimaging
- Magnetic Resonance Imaging
Background:
- Acute intracerebral and intraspinal hemorrhages require accurate diagnosis.
- Initial computed tomography (CT) and spin-echo magnetic resonance imaging (MRI) may miss chronic bleeding evidence.
- T2*-weighted gradient-echo MRI is a specialized sequence sensitive to hemosiderin deposits.
Observation:
- Four patients with acute hemorrhage underwent T2*-weighted gradient-echo MRI.
- This MRI sequence revealed numerous hemosiderin deposits from prior, undetected hemorrhages.
- Hemosiderin distribution patterns suggested specific underlying pathologies.
Findings:
- Hypertensive microangiopathy: Deep brain structure hemosiderin deposits.
- Cerebral amyloid angiopathy: Cortico-subcortical hemorrhage distribution.
- Multiple cavernomas: Diffuse bleeding, spinal involvement, calcification.
- New subclinical hemorrhages detected on follow-up T2*-weighted imaging.
Implications:
- T2*-weighted gradient-echo MRI provides crucial diagnostic information beyond initial assessments.
- It aids in differentiating causes of hemorrhage based on lesion distribution.
- Routine use of T2*-weighted gradient-echo MRI is recommended for patients with acute intracranial and spinal bleeding.