(Stroke. 1999;30:2263-2267.)
© 1999 American Heart Association, Inc.
Original Contributions |
MRI Features of Intracerebral Hemorrhage Within 2 Hours From Symptom Onset
From the Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (I.L., R.H.L., L.R.C.), and Section of Stroke Diagnostics and Therapeutics, Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md (S.W.).
Correspondence to Italo Linfante, MD, Department of Neurology, Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center, East Campus DA 779, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115. E-mail ilinfant{at}caregroup.harvard.edu
Background and Purpose—MRI has been increasingly used in the evaluation of acute stroke patients. However, MRI must be able to detect early hemorrhage to be the only imaging screen used before treatment such as thrombolysis. Susceptibility-weighted imaging, an echo-planar T2* sequence, can show intracerebral hemorrhage (ICH) in patients imaged between 2.5 and 5 hours from symptom onset. It is unknown whether MRI can detect ICH earlier than 2.5 hours. We describe 5 patients with ICH who had MRI between 23 and 120 minutes from symptom onset and propose diagnostic patterns of evolution of hyperacute ICH on MRI.
Methods—As part of our acute imaging protocol, all patients with acute stroke within 24 hours from symptom onset were imaged with a set of sequences that included susceptibility-weighted imaging, diffusion- and perfusion-weighted imaging, T1- and T2-weighted imaging, fluid-attenuated inversion recovery (FLAIR), and MR angiography using echo-planar techniques. Five patients with ICH had MRI between 23 and 120 minutes from the onset of symptoms.
Results—ICH was identified in all patients. Distinctive patterns of hyperacute ICH and absence of signs of ischemic stroke were the hallmark features of this diagnosis. The hyperacute hematoma appears to be composed of 3 distinct areas: (1) center: isointense to hyperintense heterogeneous signal on susceptibility-weighted and T2-weighted imaging; (2) periphery: hypointense (susceptibility effect) on susceptibility-weighted and T2-weighted imaging; and (3) rim: hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, representing vasogenic edema encasing the hematoma.
Conclusions—MRI is able to detect hyperacute ICH and show a pattern of evolution of the hematoma within 2 hours from the onset of symptoms.
Key Words: hemoglobins • intracerebral hemorrhage • magnetic resonance imaging • stroke • tissue plasminogen activator
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