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MRI features of intracerebral hemorrhage within 2 hours from symptom onset
I Linfante1, R H Llinas, L R Caplan
1Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA. ilinfant@caregroup.harvard.edu
Background And Purpose:
MRI has been increasingly used in the evaluation of acute stroke patients. However, MRI must be able to detect early hemorrhage to be the only imaging screen used before treatment such as thrombolysis. Susceptibility-weighted imaging, an echo-planar T2* sequence, can show intracerebral hemorrhage (ICH) in patients imaged between 2.5 and 5 hours from symptom onset. It is unknown whether MRI can detect ICH earlier than 2.5 hours. We describe 5 patients with ICH who had MRI between 23 and 120 minutes from symptom onset and propose diagnostic patterns of evolution of hyperacute ICH on MRI.
Methods:
As part of our acute imaging protocol, all patients with acute stroke within 24 hours from symptom onset were imaged with a set of sequences that included susceptibility-weighted imaging, diffusion- and perfusion-weighted imaging, T1- and T2-weighted imaging, fluid-attenuated inversion recovery (FLAIR), and MR angiography using echo-planar techniques. Five patients with ICH had MRI between 23 and 120 minutes from the onset of symptoms.
Results:
ICH was identified in all patients. Distinctive patterns of hyperacute ICH and absence of signs of ischemic stroke were the hallmark features of this diagnosis. The hyperacute hematoma appears to be composed of 3 distinct areas: (1) center: isointense to hyperintense heterogeneous signal on susceptibility-weighted and T2-weighted imaging; (2) periphery: hypointense (susceptibility effect) on susceptibility-weighted and T2-weighted imaging; and (3) rim: hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, representing vasogenic edema encasing the hematoma.
Conclusions:
MRI is able to detect hyperacute ICH and show a pattern of evolution of the hematoma within 2 hours from the onset of symptoms.
Insights
Magnetic Resonance Imaging (MRI) can detect hyperacute intracerebral hemorrhage (ICH) within two hours of symptom onset. Specific MRI patterns identify early hematoma evolution, crucial for acute stroke diagnosis and treatment.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Magnetic Resonance Imaging (MRI) is increasingly vital for acute stroke evaluation.
- Early detection of intracerebral hemorrhage (ICH) is critical for timely treatment, such as thrombolysis.
- Susceptibility-weighted imaging (SWI) can detect ICH between 2.5 and 5 hours post-symptom onset, but earlier detection remains under investigation.
Observation:
- This study examined five patients with ICH who underwent MRI within 23 to 120 minutes of symptom onset.
- Standard acute stroke MRI protocols, including SWI, diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), T1- and T2-weighted imaging, FLAIR, and MRA, were utilized.
- Distinctive imaging patterns of hyperacute ICH were observed, differentiating it from ischemic stroke.
Findings:
- MRI successfully identified ICH in all five patients within two hours of symptom onset.
- Hyperacute hematomas exhibited a three-part structure on MRI: a heterogeneous center, a hypointense periphery due to susceptibility effects, and a hypointense/hyperintense rim indicating vasogenic edema.
- These findings suggest MRI can visualize the evolution of hyperacute ICH.
Implications:
- MRI is capable of detecting hyperacute ICH significantly earlier than previously established.
- The identified MRI patterns provide diagnostic criteria for early hematoma detection in acute stroke.
- This capability enhances MRI's role as a sole imaging modality for pre-treatment assessment in acute stroke patients.