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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
MRI scout images can detect the acute intracerebral hemorrhage on CT
Toshiyuki Hayashi1, Junya Aoki1, Kentaro Suzuki1
1Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
Introduction:
Magnetic resonance imaging (MRI) has recently emerged as a first-line tool for investigating acute stroke. However, MRI requires long scan times, which could be detrimental for severe stroke patients with a large intracerebral hemorrhage (ICH). MRI scout images, which are taken prior to a study to determine the range of subsequent images, can be used to rapidly screen the whole brain. We examined whether MRI scout imaging can detect ICHs observed by computed tomography (CT).
Methods:
Between September 2014 and March 2016, consecutive acute ICH patients who underwent both MRI scout and CT imaging in the acute setting were studied. ICHs on MRI scout images were defined as space-occupying lesions. Two neurologists independently assessed the scout images. We investigated whether ICHs on CT scans can be detected on MRI scout images and the characteristics of ICHs not detected by MRI scout images.
Results:
One hundred and forty-eight ICH patients (median age, 68 [interquartile range, 59-77] years; 99 [67%] males; median National Institutes of Health Stroke Scale score, 11 [4-17]) were enrolled. Among these, 138 (93%) patients were diagnosed as having ICH by MRI scout imaging (positive group), and 10 (7%) patients were not (negative group). The bleeding volume was 9.3 [4.5-22.4] ml in the positive group and 1.0 [0.4-2.0] ml in the negative group (p < .001). The cut-off value of bleeding volume calculated from the receiver operating characteristic curve was 2.0 ml. Regarding ICH lesions, 4 (44%) of the 9 pontine hemorrhages were detected on MRI scout images, whereas 134 (96%) of the 139 other hemorrhages were diagnosed (p < .001).
Conclusions:
We diagnosed >90% of ICHs using MRI scout images. Low levels of ICH and pontine hemorrhaging might be difficult to detect using MRI scout imaging.
Insights
MRI scout imaging effectively detects over 90% of intracerebral hemorrhages (ICHs). However, small hemorrhages and pontine bleeds may be missed, highlighting limitations in acute stroke diagnosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Magnetic resonance imaging (MRI) is a primary tool for acute stroke evaluation.
- Long MRI scan times pose challenges for patients with severe intracerebral hemorrhage (ICH).
- MRI scout images offer rapid, whole-brain screening potential.
Purpose of the Study:
- To assess the efficacy of MRI scout imaging in detecting acute intracerebral hemorrhages (ICHs).
- To compare MRI scout imaging detection rates against computed tomography (CT) findings.
- To identify characteristics of ICHs not detectable by MRI scout imaging.
Main Methods:
- A study of 148 acute ICH patients who underwent both MRI scout and CT imaging.
- ICHs on MRI scout images were defined as space-occupying lesions.
- Independent assessment by two neurologists to evaluate detection rates and missed ICH characteristics.
Main Results:
- MRI scout imaging detected ICH in 93% (138/148) of patients.
- The median bleeding volume in detected ICHs was significantly higher than in undetected cases (9.3 mL vs. 1.0 mL).
- Detection rates were lower for pontine hemorrhages (44%) compared to other ICH locations (96%).
Conclusions:
- MRI scout imaging is a reliable method for diagnosing over 90% of acute ICHs.
- Small ICH volumes and pontine hemorrhages present challenges for detection using MRI scout imaging.
- MRI scout imaging shows promise for rapid ICH screening in acute stroke settings.
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