Hyperacute intraventricular hemorrhage: detection and characterization, a comparison between 5 MRI sequences

We aimed to evaluate the diagnostic accuracy of MRI for detecting early intraventricular hemorrhage (IVH) (within 6 hours after hemorrhage and to describe the MR features that allow diagnosis. For this purpose, MR data of 22 patients with hyperacute intraparenchymal hemorrhage were independently rated as negative or positive for IVH by two observers, in a blind, retrospective study taking computed tomography (CT) as providing the correct diagnosis of IVH. Sensitivity, specificity, intra- and interobserver agreement were assessed. On FSE-FLAIR, EPI-GRE-T2* and DWI images, all cases of IVH were correctly rated (sensitivity of 100%). For b0 EPI images, obtained from diffusion-weighted echo planar sequences, one case of IVH was missed by one reader (sensitivity of 88%). For T1 images, one patient was incorrectly rated negative for IVH by the two readers (sensitivity of 90%). Three forms of IVH were described, including clotted hematoma, layered hemorrhage and red blood cell deposit. When CT images were obtained within a time span of less than 3 hours after MRI, volume was assessed. Volume of hemorrhage on CT correlated best with DWI images but was underestimated on EPI-GRE T2* images.