Histopathologic Analysis of Foci of Signal Loss on Gradient-Echo T2*-Weighted MR Images in Patients with Spontaneous Intracerebral Hemorrhage: Evidence of Microangiopathy-Related Microbleeds
Franz Fazekas
,a,
Reinhold Kleinerta,
Gudrun Rooba,
Gertrude Kleinerta,
Peter Kapellera,
Reinhold Schmidta and
Hans-Peter Hartunga
a From the Department of Neurology (F.F., G.R., G.K., P.K., R.S., H-P.H.), the MR Institute (F.F., P.K., R.S.), and the Institute of Pathology, Laboratory of Neuropathology (R.K.), Karl-Franzens University, Graz, Austria.
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FIG 1. Patient 6.
A and B, Postmortem gradient-echo T2*-weighted MR images (600/15/2; flip angle, 25°) show foci of signal hypointensity in the basal ganglia bilaterally and in the left thalamus (arrows, A). Note signal loss at the surface of the specimen due to field inhomogeneity and subarachnoid blood. Foci of signal loss are also noted in the cerebellum and pons (arrow, B).
C, Histopathologic section shows an old microbleed (arrow), corresponding to the largest hypointensity (corresponding arrows in B and C).
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FIG 2. Cerebral amyloid angiopathy in area showing hypointense MR lesion. Yellow-green birefringency of amyloid deposits in the vessel walls under polarized light corresponds to bright spots and perivascular leakage of erythrocytes (arrow). Temporal cortex, polarization optics; alkaline Congo stain, original magnification x32.
FIG 3. A, MR-positive old microbleed with a diameter of 2 to 3 mm in the subcortical white matter. Numerous darkly stained hemosiderophages are seen in the center, close to a ruptured vessel (arrows). There is extensive perivascular edema. Masson trichrome stain, original magnification x201.
B, Hypertensive angiopathy with dilatation of perivascular spaces and deposition of a few hemosiderin-laden macrophages (arrow) not seen on MR study. Reactive astrocytes are present in the surrounding neuropil. Masson trichrome stain, original magnification x162.
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