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(Stroke. 2004;35:502.)
© 2004 American Heart Association, Inc.

Original Contributions

Stroke Magnetic Resonance Imaging Is Accurate in Hyperacute Intracerebral Hemorrhage

A Multicenter Study on the Validity of Stroke Imaging

Jochen B. Fiebach, MD; Peter D. Schellinger, MD; Achim Gass, MD; Thomas Kucinski, MD; Mario Siebler, MD; Arno Villringer, MD; Peter Ölkers, MD; Jochen G. Hirsch, PhD; Sabine Heiland, PhD; Philipp Wilde; Olav Jansen, MD; Joachim Röther, MD; Werner Hacke, MD Klaus Sartor, MD for the Kompetenznetzwerk Schlaganfall B5

From the Departments of Neuroradiology (J.B.F., S.H., P.W., K.S.) and Neurology (P.D.S., W.H.), University of Heidelberg; Department of Neurology (A.G., J.H.), University of Mannheim; Departments of Neuroradiology (T.K.) and Neurology (J.R.), University of Hamburg; Department of Neurology (M.S.), University of Düsseldorf; Department of Neurology (A.V.), University of Berlin; Department of Neuroradiology (P.Ö.), University of Mainz, and Department of Neuroradiology (O.J.), University of Keil, Germany.

Correspondence to Dr Med Jochen B. Fiebach, Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. E-mail Jochen_Fiebach{at}med.uni-heidelberg.de

Background and Purpose— Although modern multisequence stroke MRI protocols are an emerging imaging routine for the diagnostic assessment of acute ischemic stroke, their sensitivity for intracerebral hemorrhage (ICH), the most important differential diagnosis, is still a matter of debate. We hypothesized that stroke MRI is accurate in the detection of ICH. To evaluate our hypotheses, we conducted a prospective multicenter trial.

Methods— Stroke MRI protocols of 6 university hospitals were standardized. Images from 62 ICH patients and 62 nonhemorrhagic stroke patients, all imaged within the first 6 hours after symptom onset (mean, 3 hours 18 minutes), were analyzed. For diagnosis of hemorrhage, CT served as the "gold standard." Three readers experienced in stroke imaging and 3 final-year medical students, unaware of clinical details, separately evaluated sets of diffusion-, T2-, and T2*-weighted images. The extent and phenomenology of the hemorrhage on MRI were assessed separately.

Results— Mean patient age was 65.5 years; median National Institutes of Health Stroke Scale score was 10. The experienced readers identified ICH with 100% sensitivity (confidence interval, 97.1 to 100) and 100% overall accuracy. Mean ICH size was 17.3 mL (range, 1 to 101.5 mL). The students reached a mean sensitivity of 95.16% (confidence interval, 90.32 to 98.39).

Conclusions— Hyperacute ICH causes a characteristic imaging pattern on stroke MRI and is detectable with excellent accuracy. Even raters with limited film-reading experience reached good accuracy. Stroke MRI alone can rule out ICH and demonstrate the underlying pathology in hyperacute stroke.

Key Words: hemorrhage • magnetic resonance imaging • magnetic resonance imaging, diffusion-weighted • stroke

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