doi: 10.1161/01.STR.0000019882.06696.D6
(Stroke. 2002;33:1748.)
© 2002 American Heart Association, Inc.
Letters to the Editor |
MRI: The New Gold Standard for Detecting Brain Hemorrhage?
Department of Neuroradiology, Technische Universität, Dresden, Germany
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
To the Editor:
Computed tomography (CT) is widely considered as the gold standard to image brain hemorrhage. The main argument not to use MRI in acute stroke patients is its assumed low sensitivity for intracranial blood. Kidwell et al and Nighoghossian et al are to be congratulated for contributing important observations to the discussion about the capabilities of MRI in acute stroke.1,2 Using T2*-weighted MR sequences, Kidwell et al found small deposits of hemosiderin in 5 of 41 acute stroke patients (12%, 95% CI 5% to 26%). Nighoghossian et al found traces of microbleeds in 20 of 100 of their prospectively examined stroke patients (20%, 13% to 29%). Higher incidences of cerebral microbleeds were seen in patients with primary intracerebral hemorrhages3 and with CADASIL.4
The hemosiderin deposits of cerebral microbleeds remain undetected by CT and may represent a risk for clinically relevant hemorrhages if the patients are treated with antithrombotic agents. Because of the small numbers of patients, both studies could not determine the clinical relevance and the impact of these findings on thrombolytic therapy.
Nighoghossian et al may have missed another important aspect of their findings: in their Figure 1, they presented the CT scan of an acute stroke patient with hypoattenuation of the right lentiform nucleus (hardly visible, because of the very low quality of image reproduction). The MRI of this patient was obtained immediately after the CT and showed a signal loss of the affected brain region on a T2*-weighted sequence indicating acute hemorrhage. CT and MRI confirmed a middle
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