Magnetic resonance imaging of subarachnoid hemorrhage

Magnetic resonance (MR) imaging of subarachnoid hemorrhage (SAH) due to a ruptured aneurysm has been evaluated in relation to CT findings on 30 patients. In the acute stage, particularly less than 24 hours after the bleeding episode (25 patients), SAH appeared of high intensity relative to the surrounding brain on a T-2 weighted SE image but isointense where the corresponding CT scan showed blood clot of attenuation value over 60 H. A T-2 weighted SE image was able to reveal subtle evidence of SAH not visible on the CT scan. The T-1 weighted IR image was not as sensitive. Blood clot (HU greater than 60) appeared isointense, but mild and moderate SAH (HU less than 60) was indistinguishable from normal CSF. MR imaging was also sensitive to subacute and chronic SAH (5 patients). Three out of four SAH appearing normal on CT showed high intensity on T-2 weighted images. Thirteen out of 24 aneurysms (54%) larger than 5 mm in diameter on angiography were detected on T-2 weighted images. Smaller aneurysms less than 4 mm were not visualized. MR imaging was able to indicate the ruptured one in cases of multiple aneurysms by showing hemorrhagic lesions more clearly than CT. We conclude that MR imaging is very helpful for diagnosing SAH, particularly when CT is normal, and in indicating aneurysm location as well as rupture site.