Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging.

BACKGROUND: MRI has become increasingly used in the acute setting to manage patients with stroke. There has been concern that MRI may not be sensitive in the detection of acute intracranial hemorrhage. We assessed whether strongly susceptibility-weighted MRI would be sensitive to intraparenchymal hemorrhage in the first few hours.

CASE DESCRIPTIONS: In the course of our ongoing studies of MRI of acute ischemic stroke in more than 200 patients, 35 patients had MR studies within 6 hours. Six of these patients who presented with acute focal symptoms with definite time of clinical onset (2.5 to 5 hours) were found to have evidence of intraparenchymal hemorrhage. Standard T1- and T2-weighted MR scans were performed. In 5 of the patients, echo-planar imaging and gradient-echo sequences were performed to increase the sensitivity of magnetic susceptibility effects of the pulse sequences. Four of the cases were of putaminal hemorrhage and 2 were lobar hemorrhages. The hemorrhage was most evident as foci of T2* hypointensity (signal loss) and unambiguous on the more susceptibility-weighted sequences, particularly echo-planar gradient-echo images.

CONCLUSIONS: MRI can detect hemorrhage within 2.5 to 5 hours of onset of clinical symptoms as regions of marked signal loss due to susceptibility effects, whereas conventional MR scans of ischemic stroke may appear normal. These results demonstrate that MR susceptibility sequences may be sensitive to hyperacute hemorrhage and suggest that MR may be an adequate screen for primary intraparenchymal hemorrhage.