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MRI in acute subarachnoid haemorrhage; findings with a standardised stroke protocol

J B Fiebach1, P D Schellinger, K Geletneky

  • 1Division of Neuroradiology, Department of Neurology, University of Heidelberg Medical Centre, Im Neuenheimer Feld 400, 69120, Germany. Jochen_Fiebach@med.uni-heidelberg.de

Neuroradiology
|December 5, 2003
PubMed

Insights

Acute subarachnoid hemorrhage (SAH) is visible on MRI within 6 hours of symptom onset. Standard stroke MRI protocols, particularly proton density-weighted images, clearly detect SAH, aiding early diagnosis.

Area of Science:

  • Neuroradiology
  • Neuroimaging

Background:

  • Acute subarachnoid hemorrhage (SAH) diagnosis can be challenging.
  • The visibility of acute SAH on Magnetic Resonance Imaging (MRI) remains uncertain.

Purpose of the Study:

  • To investigate the detectability of acute subarachnoid hemorrhage (SAH) using MRI within 6 hours of symptom onset.
  • To identify specific MRI patterns indicative of early SAH.

Main Methods:

  • Utilized a standard stroke MRI protocol including multiecho proton density (PD)- and T2-weighted images.
  • Employed echoplanar (EPI) diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and MR angiography (MRA).
  • Scanned five patients with CT-diagnosed minor SAH (Hunt and Hess grades 1 or 2) within 6 hours of symptom onset.

Main Results:

  • Subarachnoid hemorrhage (SAH) was clearly visible on proton density (PD)-weighted images with a short echo time (TE) in all patients.
  • Diffusion-weighted imaging (DWI) showed high signal in SAH in four patients.
  • A low-signal rim on T2*-weighted images was observed in four patients; however, in one perimesencephalic SAH case, susceptibility effects obscured findings on EPI DWI and T2*-weighted images.
  • Perfusion maps were normal in all cases, and only one patient had an aneurysm detected by MRA and conventional angiography.

Conclusions:

  • Standard stroke MRI protocols, especially PD-weighted imaging, can effectively visualize acute subarachnoid hemorrhage (SAH) within 6 hours of symptom onset.
  • Characteristic MRI patterns aid in the early detection of SAH.
  • While generally effective, specific SAH locations may present challenges for certain MRI sequences like EPI DWI.

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