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MR imaging in pretruncal nonaneurysmal subarachnoid hemorrhage: is it worthwhile?
E F Wijdicks1, W I Schievink, G M Miller
1Departments of Neurology, Mayo Clinic, Rochester, Minnesota, USA. wijde@mayo.edu
Stroke
|December 4, 1998
Summary
Magnetic Resonance Imaging (MRI) did not identify the cause of pretruncal nonaneurysmal subarachnoid hemorrhage. The diagnostic value of MRI for this condition is limited and likely does not outweigh its cost.
Area of Science:
- Neurology
- Radiology
- Neuroradiology
Background:
- The etiology of pretruncal (perimesencephalic) nonaneurysmal subarachnoid hemorrhage remains unknown.
- Magnetic Resonance Imaging (MRI) is frequently employed to rule out vascular abnormalities in these cases, but its diagnostic utility is uncertain.
Purpose of the Study:
- To evaluate the diagnostic value of brain and spine MRI in identifying the source of pretruncal nonaneurysmal subarachnoid hemorrhage.
- To assess the effectiveness of advanced MRI techniques in detecting vascular abnormalities.
Main Methods:
- Brain MRI was performed using routine sequences, gadolinium enhancement, and thin T1-weighted axial sections after triple-dose contrast.
- Fluid-attenuated inversion recovery (FLAIR) MRI was utilized to detect blood in sulci.
- Spine MRI was conducted in a subset of patients.
Main Results:
- MRI confirmed the focal nature of pretruncal subarachnoid hemorrhage in 14 of 18 patients studied within 7 days.
- No vascular abnormalities were identified in 17 patients, including 14 who received gadolinium enhancement.
- Spine MRI revealed no arteriovenous malformations in five patients.
Conclusions:
- Brain and spine MRI did not reveal the source of pretruncal nonaneurysmal subarachnoid hemorrhage in the studied cohort.
- The cost-effectiveness of MRI for evaluating this specific type of subarachnoid hemorrhage is questionable, suggesting limited diagnostic benefit.