Intracerebral hemorrhage MRI: Difference between revisions
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*T2 susceptibility-weighted MRI are as sensitive as CT for detection of acute blood and are more sensitive for identification of prior hemorrhage.<ref name="pmid17258669">{{cite journal| author=Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM et al.| title=Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. | journal=Lancet | year= 2007 | volume= 369 | issue= 9558 | pages= 293-8 | pmid=17258669 | doi=10.1016/S0140-6736(07)60151-2 | pmc=1859855 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17258669 }} </ref> | *T2 susceptibility-weighted MRI are as sensitive as CT for detection of acute blood and are more sensitive for identification of prior hemorrhage.<ref name="pmid17258669">{{cite journal| author=Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM et al.| title=Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. | journal=Lancet | year= 2007 | volume= 369 | issue= 9558 | pages= 293-8 | pmid=17258669 | doi=10.1016/S0140-6736(07)60151-2 | pmc=1859855 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17258669 }} </ref> | ||
*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). | *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: | *As the [[hematoma]] ages, [[hemoglobin]] (Hb) goes through the following stages:<ref name="pmid8372185">{{cite journal| author=Bradley WG| title=MR appearance of hemorrhage in the brain. | journal=Radiology | year= 1993 | volume= 189 | issue= 1 | pages= 15-26 | pmid=8372185 | doi=10.1148/radiology.189.1.8372185 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8372185 }}</ref> | ||
**Initial 7 days: | **Initial 7 days: [[Oxyhemoglobin|Oxy-Hb]]→[[Deoxyhemoglobin|Deoxy-Hb]]→[[Methemoglobin|Met-Hb]] | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 35: | Line 34: | ||
|- | |- | ||
|Early subacute | |Early subacute | ||
|>3 days | |> 3 days | ||
|Intracellular [[Methemoglobin|met-Hb]] | |Intracellular [[Methemoglobin|met-Hb]] | ||
|Very hyperintense | |Very hyperintense | ||
| Line 41: | Line 40: | ||
|- | |- | ||
|Late subacute | |Late subacute | ||
|>7 days | |> 7 days | ||
|Extracellular [[Methemoglobin|met-Hb]] | |Extracellular [[Methemoglobin|met-Hb]] | ||
|Very hyperintense | |Very hyperintense | ||
| Line 47: | Line 46: | ||
|- | |- | ||
|Chronic center | |Chronic center | ||
|>14 days | |> 14 days | ||
|Extracellular hemichromes | |Extracellular hemichromes | ||
|Isointense | |Isointense | ||
| Line 53: | Line 52: | ||
|- | |- | ||
|Chronic rim | |Chronic rim | ||
|>14 days | |> 14 days | ||
|Intracellular [[hemosiderin]] | |Intracellular [[hemosiderin]] | ||
|Slightly hypointense | |Slightly hypointense | ||
|Very hypointense | |Very hypointense | ||
|} | |} | ||
===Microbleeds=== | |||
Cerebral microbleeds are best visualized on T2* weighted GRE sequences as punctate areas of low signal.<ref name="pmid21233474">{{cite journal| author=Altmann-Schneider I, Trompet S, de Craen AJ, van Es AC, Jukema JW, Stott DJ et al.| title=Cerebral microbleeds are predictive of mortality in the elderly. | journal=Stroke | year= 2011 | volume= 42 | issue= 3 | pages= 638-44 | pmid=21233474 | doi=10.1161/STROKEAHA.110.595611 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21233474 }}</ref><ref name="pmid22949472">{{cite journal| author=Liu W, Liu R, Sun W, Peng Q, Zhang W, Xu E et al.| title=Different impacts of blood pressure variability on the progression of cerebral microbleeds and white matter lesions. | journal=Stroke | year= 2012 | volume= 43 | issue= 11 | pages= 2916-22 | pmid=22949472 | doi=10.1161/STROKEAHA.112.658369 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949472 }}</ref> | |||
==Images== | ==Images== | ||
Latest revision as of 20:19, 30 November 2016
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Intracerebral hemorrhage Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) |
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AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) |
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Case Studies |
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Intracerebral hemorrhage MRI On the Web |
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American Roentgen Ray Society Images of Intracerebral hemorrhage MRI |
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Risk calculators and risk factors for 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]
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Axial T1 -
T2 -
Sagittal T1 C+
References
- ↑ 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.
- ↑ Bradley WG (1993). "MR appearance of hemorrhage in the brain". Radiology. 189 (1): 15–26. doi:10.1148/radiology.189.1.8372185. PMID 8372185.
- ↑ 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.
- ↑ 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.
- ↑ Intracerebral Hemotrrhage https://radiopaedia.org/cases/intracerebral-haemorrhage-2 Accessed on November 9, 2016