Acute intracranial hemorrhage: intensity changes on sequential MR scans at 0.5 T

Thirty-seven patients underwent MR imaging at 0.5 T within 7 days of a CT-documented intracranial hemorrhage. A total of 57 hematomas were evaluated. Twelve patients underwent serial scanning and 12 patients had multiple hemorrhages into different intracranial compartments. The appearances of the hematomas on spin-echo (SE) images with a short repetition time (TR) of 500 msec and short echo time (TE) of 32 msec (SE 500/32), long TR/intermediate TE (SE 2000/60), and long TR/long TE (SE 2000/120) were carefully evaluated with specific attention to the precise time after ictus. Hematomas showed heterogeneous, complex, rapidly changing intensities. There was a significant amount of variation among patients, especially between the third and seventh days. Hematomas studied between 12 and 24 hr after hemorrhage were mildly hyperintense on short TR scans and markedly hyperintense on long TR (intermediate and long TE) scans (stage I). These findings in acute hemorrhage have received little prior attention. Over the next 1-2 days, hematomas became iso- to mildly hypointense on short TR scans and markedly hypointense on long TR scans (stage II). Hypointensity on long TR scans has previously been described at high field strengths; our communication demonstrates that this phenomenon is seen routinely at intermediate field strengths as well. Hematomas became markedly hyperintense on short TR scans beginning on approximately the fourth day postictus and redeveloped hyperintensity on long TR scans approximately 5-6 days after ictus (stage III). By the end of the first week they were hyperintense on all pulse sequences (stage IV). MR findings on the first day after intracranial hemorrhage (in particular, subtle hyperintensity on short TR scans) probably allow for a specific diagnosis, while the variable, hetergeneous, and rapidly changing intensities noted between days 2 and 7 are often less specific.