Pitfalls in the Imaging Interpretation of Intracranial Hemorrhage

Area of Science:

• Neuroradiology
• Medical Imaging
• Neurology

Background:

• Intracranial hemorrhage (ICH) is a frequent finding on emergent head CT scans.
• ICH can present with varying attenuation values, mimicking other pathologies.
• Accurate initial interpretation is crucial for timely patient management.

Purpose of the Study:

• To review key imaging findings and technical considerations for intracranial hemorrhage (ICH) on CT.
• To discuss common and uncommon pitfalls in diagnosing ICH on CT.
• To highlight the role of MRI as a problem-solving technique for ICH.

Main Methods:

• Review of common and uncommon pitfalls in the interpretation of intracranial hemorrhage (ICH) on computed tomography (CT).
• Discussion of alternative diagnoses that mimic ICH on CT.
• Evaluation of magnetic resonance imaging (MRI) techniques for characterizing hemorrhage.

Main Results:

• ICH typically appears as hyperattenuation on CT but can be isoattenuating, posing diagnostic challenges.
• Mimics of ICH on CT include calcifications, vascular malformations, tumors, contrast, and artifacts.
• Dual-energy CT can aid differentiation, but MRI, especially with gradient echo or susceptibility-weighted imaging, offers improved hemorrhage characterization.

Conclusions:

• Radiologists play a critical role in identifying ICH pitfalls on initial CT scans.
• Recognizing potential mimics and recommending appropriate work-up, including MRI, is essential.
• Advanced MRI sequences improve the characterization of intracranial hemorrhage, serving as a valuable problem-solving tool.