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Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging
M R Patel1, R R Edelman, S Warach
1Department of Radiology, Beth Israel Hospital, Boston, Mass 02115, USA. mpatel@bih.harvard.edu
Background:
MRI has become increasingly used in the acute setting to manage patients with stroke. There has been concern that MRI may not be sensitive in the detection of acute intracranial hemorrhage. We assessed whether strongly susceptibility-weighted MRI would be sensitive to intraparenchymal hemorrhage in the first few hours.
Case Descriptions:
In the course of our ongoing studies of MRI of acute ischemic stroke in more than 200 patients, 35 patients had MR studies within 6 hours. Six of these patients who presented with acute focal symptoms with definite time of clinical onset (2.5 to 5 hours) were found to have evidence of intraparenchymal hemorrhage. Standard T1- and T2-weighted MR scans were performed. In 5 of the patients, echo-planar imaging and gradient-echo sequences were performed to increase the sensitivity of magnetic susceptibility effects of the pulse sequences. Four of the cases were of putaminal hemorrhage and 2 were lobar hemorrhages. The hemorrhage was most evident as foci of T2* hypointensity (signal loss) and unambiguous on the more susceptibility-weighted sequences, particularly echo-planar gradient-echo images.
Conclusions:
MRI can detect hemorrhage within 2.5 to 5 hours of onset of clinical symptoms as regions of marked signal loss due to susceptibility effects, whereas conventional MR scans of ischemic stroke may appear normal. These results demonstrate that MR susceptibility sequences may be sensitive to hyperacute hemorrhage and suggest that MR may be an adequate screen for primary intraparenchymal hemorrhage.
Insights
Magnetic resonance imaging (MRI) can detect acute intracranial hemorrhage within hours of symptom onset. Susceptibility-weighted MRI sequences show high sensitivity for identifying early-stage brain bleeds.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Magnetic resonance imaging (MRI) is vital for acute stroke management.
- Concerns exist regarding MRI's sensitivity in detecting acute intracranial hemorrhage (ICH).
- This study evaluates susceptibility-weighted MRI for early ICH detection.
Observation:
- 35 stroke patients underwent MRI within 6 hours of symptom onset.
- Six patients presented with acute focal symptoms and confirmed intraparenchymal hemorrhage (IPH).
- Hemorrhage appeared as T2* hypointensity, particularly on echo-planar gradient-echo sequences.
Findings:
- MRI detected hemorrhage 2.5 to 5 hours post-symptom onset.
- Susceptibility-weighted sequences revealed marked signal loss in hyperacute hemorrhages.
- Conventional MRI scans for ischemic stroke may appear normal despite hemorrhage.
Implications:
- Susceptibility-weighted MRI sequences show promise for detecting hyperacute intracranial hemorrhage.
- MRI may serve as an adequate screening tool for primary intraparenchymal hemorrhage.
- Advanced MRI techniques enhance sensitivity for early detection of brain bleeds.