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FIG 1. Increased conspicuity of HT and upgrade in bleeding categorization at 24 hours by using the different sequences. The patient is a 75-year-old woman admitted 24 hours previously for aphasia, right hemiparesis, and right conjugate ocular deviation who was treated by a combination of 450 mg ASA and low-dose low molecular heparinoids.
A, Axial CT scan, showing an ambiguous isoattenuated area within infarcted left PCA territory, which was ultimately rated as "HI1" after extended debate. The hemorrhagic area displays a similar attenuation as the normal parenchyma raising the hypothesis of spared tissue rather than petechial HT. Consensual interobserver rating of "HI2" was retained.
B, FSE-FLAIR image, showing punctuate hypointense foci confirming petechial hemorrhage and the "HI2" rating.
C, EPI-SE T2-weighted image, demonstrating homogeneous, round hypointense area rated as "PH1" because of the clotlike aspect of the bleeding, without mass effect but with the presence of a surrounding hyperintense ring of ischemic tissue.
D, EPI-GRE T2*-weighted image, demonstrating enlargement of the hemorrhagic area resulting in "PH2" rating since the hypointense artifact had recovered the ring of hyperintense ischemic tissue seen on FSE-FLAIR and EPI-SE T2-weighted images (previous views), thereby filling the theoretical >30% of infarct area criterion for "PH2" rating.
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