cerebral hemorrhage: mri findings - school of medicinecasemed.case.edu/clerkships/neurology/web...
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Cerebral Hemorrhage: MRI Findings
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Cerebral Hemorrhage: MRI Characteristics
Appearance on MRI is variable depending on: Field strength of the magnet Whether the image is T1 or T2 weighted Time course of the ICH
Hyperacute <24 hours Acute 1-3 days Subacute Early > 3 Days Late > 7 Days
Chronic > 14 Days
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Hemoglobin Changes Following Cerebral Hemorrhage
Blood in the Hematoma
Oxyhemoglobin (intracelluar)
Deoxyhemoglobin (intracellular)
Methemoglobin (intracellular)
Methemoglobin (extracelluar)
Hemosiderin
1-3 Days
3+ Days
7 + Days
14 + Days
Immediate
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T1 Weighted T2 Weighted
Normal Brain
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T1 Weighted T2 Weighted
Hyperacute (<24 hours) ICH
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T1 Weighted T2 Weighted
This results in a slightly hypointense signal on T1
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T1 Weighted T2 Weighted
And a slightly hyperintense signal on T2
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T1 Weighted T2 Weighted
This pattern is not specific and is seen in many other types of pathology
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T1 Weighted T2 Weighted
Oxyhemoglobin then changes to Deoxyhemoglobin within intact RBCs
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T1 Weighted T2 Weighted
This first occurs at the periphery of the ICH
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T1 Weighted T2 Weighted
In addition, enough time has passed that vasogenic edema develops around the ICH
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T1 Weighted T2 Weighted
The deoxyhemoglobin results in hypointensity on T1
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T1 Weighted T2 Weighted
As well as hypointensity on T2. Because this change starts at the periphery, a dark ring surrounding a white center can be seen
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T1 Weighted T2 Weighted
The vasogenic edema results in hyperintensity on T2 surrounding the ICH
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T1 Weighted T2 Weighted
At the end of the acute stage, the oxyhemoglobin has completely changed to deoxyhemogobin
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T1 Weighted T2 Weighted
Resulting in hypointensity on T1
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T1 Weighted T2 Weighted
And hypointensity on T2
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T1 Weighted T2 Weighted
Vasogenic edema surrounding the ICH remains hyperintense on T2
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T1 Weighted T2 Weighted
Subacute early (+ 3 Days) ICH
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T1 Weighted T2 Weighted
Deoxyhemoglobin then changes to intracelluar methemoglobin
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T1 Weighted T2 Weighted
This results in hyperintensity on T1
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T1 Weighted T2 Weighted
Without any significant change on T2, which remains hypointense
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T1 Weighted T2 Weighted
As RBCs are lysed, the methemoglobin becomes extracelluar
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T1 Weighted T2 Weighted
The hyperintensity on T1 persists
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T1 Weighted T2 Weighted
However on T2, hyperintensity results from extracellular methemoglobin and the surrounding vasogenic edema
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T1 Weighted T2 Weighted
In the chronic stage, hemosiderin in gliotic brain may exist by itself or may surround a small fluid filled cavity
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T1 Weighted T2 Weighted
The hemosiderin is hypointense on T1
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T1 Weighted T2 Weighted
And hypointense on T2
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T1 Weighted T2 Weighted
Any remaining fluid is hyperintense on T2
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T1 Weighted T2 Weighted
In the absence of any fluid, hemosiderin remains, resulting in a dark signal on both T1 and T2, as a
marker of the remote hemorrhage
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