Subacute and chronic subarachnoid hemorrhage: diagnosis with fluid-attenuated inversion-recovery MR imaging

To evaluate fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) imaging in the detection of subacute and chronic subarachnoid hemorrhage.

The authors performed 19 FLAIR MR imaging examinations at 0.5 T in 14 adult patients with subarachnoid hemorrhage 3-45 days after the ictus and 22 FLAIR examinations in 22 adult control subjects. The detection of subacute and chronic subarachnoid hemorrhage on FLAIR images was compared with the detection on conventional spin-echo MR and computed tomographic (CT) images.

In the detection of subacute subarachnoid hemorrhage, FLAIR (100% detection) was significantly superior to T1-weighted imaging (36% detection, P < .01), T2-weighted imaging (0% detection, P < .02), and CT (45% detection, P < .02 [Fisher exact test]). Although FLAIR imaging (63% detection) was superior in chronic subarachnoid hemorrhage detection, there were no statistically significant differences between modalities. FLAIR imaging demonstrated all subarachnoid hemorrhage areas as high-signal-intensity areas within 18 days and up to a maximum of 45 days after the ictus. In a blind comparison, no FLAIR images acquired in control subjects were confused with those acquired in patients.

FLAIR diagnostic images are superior to conventional MR or CT images in patients with subacute subarachnoid hemorrhage.