Hemorrhage Detected Using MR Imaging in the Setting of Acute Stroke: An In Vivo Model
John Perl IIa,
Jean A. Tkacha,
Martin Porras-Jimeneza,
Michael Liebera,
Nancy Obuchowskia,
Jeffrey S. Rossa,
Xia Ping Dinga,
Paul M Ruggieria,
David M. Shearera,
Kaveh Khajavia and
Thomas J. Masaryk
,a
a From the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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FIG 1. A–F, T1-weighted (A), SD-weighted (B), T2-weighted (C), FLAIR (D), and GRE (E) MR images and CT scan (F) of SAH at the level of the cervicomedullary junction in the same canine. Blood is seen on the MR images (obtained 2 hours after ictus) as an area of high signal obscuring the CSF-brain interface on the left (arrows). This is most conspicuous on the FLAIR image (D) and is not seen to any significant degree on the T2-weighted image (C) or the CT scan (F), performed 1 hour later.
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FIG 2. A–F, T1-weighted (A), SD-weighted (B), T2-weighted (C), FLAIR (D), and GRE (E) MR images and CT scan (F) of parenchymal hemorrhage within the right hemisphere in the same canine. All MR studies were performed 2 hours after ictus and show a focus of low-signal susceptibility artifact near the vertex, which, on the 3-hour CT scan, is found to be iatrogenically introduced gas (arrow). The T1-weighted image (A) does not show the parenchymal hemorrhage, whereas the SD-weighted image shows only vague loss of the gray/white junction (arrowhead, B). T2-weighted (C) and FLAIR (D) images display the heterogeneous hematoma with a ring of low signal (arrowhead) surrounded by vasogenic edema (open arrow). GRE image (E) prominently shows only heterogeneous susceptibility effect in the area of the hematoma (arrowhead), while CT scan shows the typical high-attenuation mass (F).
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FIG 3. Hyperacute parenchymal hemorrhage.
A–C, T1-weighted (A), T2-weighted (B), and FLAIR (C) MR images obtained immediately after creation of parenchymal hemorrhage show a false-negative abnormality not detected by either reader.
D–F, T1-weighted (D), T2-weighted (E), and FLAIR (F) MR images in the same animal 1 hour after creation of the hemorrhage show the obvious abnormality in the area of the corpus callosum, consistent with hyperacute parenchymal hemorrhage. All abnormalities were detected by both readers on all sequences.
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