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How often is haemosiderin not visible on routine MRI following traumatic intracerebral haemorrhage?
1Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. jmw@skull.dcn.ed.ac.uk
Abstract:
Intracerebral haemorrhage may be visible indefinitely on MRI, due to persistence of haemosiderin in macrophages around the lesion, but it is not clear whether all haemorrhages produce haemosiderin or, if not, what proportion cannot be identified as former haemorrhages on routine MRI. We performed routine MRI (spin-echo T2- and proton-density weighted images) in 116 survivors of moderate to severe head injury, 1-5 years after injury. We reviewed the images blindly and correlated them with CT in the acute stage, to determine how many haemorrhages from the acute stage were identifiable by virtue of haemosiderin deposition on late MRI. Of 106 haemorrhages in 78 patients on CT at the time of injury, 96 (90 %) were visible as haemosiderin on late MRI. Of the old haemorrhages without haemosiderin, seven of ten were in patients where another haemorrhage with haemosiderin was still visible elsewhere in the brain. No patient or haemorrhage features explained the formation or absence of haemosiderin. Thus about 10 % of definite haematomas show no trace of haemosiderin on routine spin-echo MRI. Radiologists should be alerted to supplement routine spin-echo with gradient-echo sequences if there is a reason to suspect, or specifically exclude, prior haemorrhage.
Insights
Most intracerebral hemorrhages are visible on MRI scans years later due to haemosiderin. However, about 10% of definite hematomas lack haemosiderin, requiring advanced MRI sequences for detection.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Intracerebral hemorrhage (ICH) diagnosis and follow-up rely on neuroimaging.
- Magnetic Resonance Imaging (MRI) can detect residual hemosiderin from ICH indefinitely.
- The detectability of all ICHs on routine MRI, based on hemosiderin presence, remains unclear.
Purpose of the Study:
- To determine the proportion of acute intracerebral hemorrhages identifiable by hemosiderin deposition on late-stage MRI.
- To assess the reliability of routine MRI in detecting all prior hemorrhages.
Main Methods:
- Routine MRI (T2- and proton-density weighted spin-echo sequences) performed on 116 moderate-to-severe head injury survivors, 1-5 years post-injury.
- Blind review of MRI scans correlated with acute-stage Computed Tomography (CT) findings.
- Analysis of 106 hemorrhages identified on initial CT.
Main Results:
- 96% (90 of 106) of acute hemorrhages were visible as hemosiderin on late-stage MRI.
- Approximately 10% of definite hematomas showed no hemosiderin trace on routine spin-echo MRI.
- No specific patient or hemorrhage features predicted hemosiderin formation or absence.
Conclusions:
- Routine spin-echo MRI may fail to detect a small but significant proportion of prior intracerebral hemorrhages.
- Radiologists should consider gradient-echo sequences to supplement routine MRI when prior hemorrhage exclusion is critical.
- Advanced MRI techniques may be necessary for comprehensive detection of all past hemorrhages.