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Intracerebral hemorrhage MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

MRI is better than CT for detection of acute and chronic hemorrhage. Therefore it should be the preferred test for accurate diagnosis of patients with suspected intracerebral hemorrhage.[1]

MRI

MRI is better than CT for detection of acute and chronic hemorrhage. Therefore it should be the preferred test for accurate diagnosis of patients with suspected intracerebral hemorrhage.[1]

  • T2 susceptibility-weighted MRI are as sensitive as CT for detection of acute blood and are more sensitive for identification of prior hemorrhage.[1]
  • The appearance of Intracerebral hemorrhage on MRI depends on the age of the hematoma and the type of MR sequence (T1-MRI or T2-MRI).
  • As the hematoma ages, hemoglobin (Hb) goes through the following stages:[2]
Stage Age Hemoglobin 1-MRI 2-MRI
Hyperacute < 24 hours Intracellular oxy-Hb Isointense Very hyperintense
Acute 1-3 days Intracellular deoxy-Hb Slightly hypointense Very hypointense
Early subacute > 3 days Intracellular met-Hb Very hyperintense Very hypointense
Late subacute > 7 days Extracellular met-Hb Very hyperintense Very hypointense
Chronic center > 14 days Extracellular hemichromes Isointense Very hyperintense
Chronic rim > 14 days Intracellular hemosiderin Slightly hypointense Very hypointense

Microbleeds

Cerebral microbleeds are best visualized on T2* weighted GRE sequences as punctate areas of low signal.[3][4]

Images

The following are images associated with intracerebral hemorrhage involves the left lentiform nucleus and internal capsule.[5]

  • Axial T1
    Axial T1
  • T2
    T2
  • Sagittal T1 C+
    Sagittal T1 C+


References

  1. ↑ 1.0 1.1 1.2 Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM; et al. (2007). “Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison”. Lancet. 369 (9558): 293–8. doi:10.1016/S0140-6736(07)60151-2. PMC 1859855. PMID 17258669.
  2. ↑ Bradley WG (1993). “MR appearance of hemorrhage in the brain”. Radiology. 189 (1): 15–26. doi:10.1148/radiology.189.1.8372185. PMID 8372185.
  3. ↑ Altmann-Schneider I, Trompet S, de Craen AJ, van Es AC, Jukema JW, Stott DJ; et al. (2011). “Cerebral microbleeds are predictive of mortality in the elderly”. Stroke. 42 (3): 638–44. doi:10.1161/STROKEAHA.110.595611. PMID 21233474.
  4. ↑ Liu W, Liu R, Sun W, Peng Q, Zhang W, Xu E; et al. (2012). “Different impacts of blood pressure variability on the progression of cerebral microbleeds and white matter lesions”. Stroke. 43 (11): 2916–22. doi:10.1161/STROKEAHA.112.658369. PMID 22949472.
  5. ↑ Intracerebral Hemotrrhage https://radiopaedia.org/cases/intracerebral-haemorrhage-2 Accessed on November 9, 2016


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