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(Stroke. 1999;30:1974-1981.)
© 1999 American Heart Association, Inc.

Letters to the Editor

A Standardized MRI Stroke Protocol: Comparison with CT in Hyperacute Intracerebral Hemorrhage

David C. Tong, MD Gregory W. Albers, MD

Department of Neurology, Stanford Stroke Center

Midori A. Yenari, MD

Departments of Neurology, and Neurological Sciences & Neurosurgery, Stanford Stroke Center

Michael P. Marks, MD

Department of Radiology, Stanford University Medical Center, Palo Alto, California

	Introduction

 
To the Editor:

We read with great interest the article by Schellinger et al¹ regarding the use of MRI for detection of intracranial hemorrhage and applaud the efforts of the authors in performing these difficult studies. We have also observed that MRI is capable of detecting early acute cerebral hemorrhage and find the potential of MRI in this setting extremely promising. However, although we strongly agree that there is growing evidence that MRI is more sensitive than previously believed for the detection of acute intracranial hemorrhage, we also urge caution. It may be somewhat premature to declare that MRI is "as good as CT"¹ for the exclusion of parenchymal hemorrhage in acute stroke patients.

Current evidence supporting the use of MRI alone in this situation is based on only a handful of patients.^{1 2} In addition, the hemorrhages detected to date, including the hemorrhages in this series, have been relatively large (>2.0 cm in diameter), which increases the probability of detection. No data have been reported on smaller, less-easily detected hemorrhages, which could still be at risk for worsening if a thrombolytic is administered. In addition, the possibility of MRI overestimating the degree of bleeding in patients with petechial hemorrhage undetectable on CT has not been studied. This could potentially lead to exclusion of patients who might otherwise benefit from thrombolysis. The problem of ruling out subarachnoid hemorrhage is also a concern, as appropriately pointed out by the authors.

We strongly agree that the use of MRI instead of CT for . . . [Full Text of this Article]

Peter D. Schellinger, MD Werner Hacke, MD

Department of Neurology

Olav Jansen, MD; Jochen B. Fiebach, MD Klaus Sartor, MD

Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany