Original articleHyperacute intraventricular hemorrhage: detection and characterization, a comparison between 5 MRI sequencesHémorragie intraventriculaire en phase hyperaiguë : détection et caractérisation à partir de cinq séquences IRM
Introduction
During the last decade, MR imaging has been increasingly used as the primary imaging tool for patients with suspicion of acute stroke. Although CT is still the usual means for detecting early hemorrhage, several studies support the use of early MR imaging for this purpose [1], [8], [12], [14], [16], [17], [18] owing to its high sensitivity for identifying early blood degradation products. Despite the fact that appearance and progression of intraparenchymal hemorrhage (IPH) on MR images have received extensive study over the past several years [2], [3], [6], [7], [9], [10], [11], [15], the appearance of intraventricular blood, within the first few hours, has rarely come to clinical attention. In an early report, Bakshi et al. was the first group to describe two forms of intraventricular hemorrhage (IVH) by MRI, a fixed clot or a free- flowing mixture layering with cerebrospinal fluid (CSF), with or without blood -CSF level [4]. Later, they showed that FLAIR MR imaging was very sensitive to acute and subacute intraventricular hemorrhage [5]. The present study was conducted:
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to evaluate the sensitivity of MRI in the detection of hyperacute IVH, associated with deep, large hematoma, among 5 different MR sequences, using CT as the gold standard;
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and to investigate the appearance of intraventricular blood.
We tested the hypothesis that early MR imaging, using a standardized stroke protocol, would be effective and reliable in the diagnosis of hyperacute IVH with high sensitivity and specificity.
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Study population
After a retrospective review of the stroke unit reports of our hospital between November 1997 and April 2004, two-hundred and five consecutive patients (N = 205) with acute stroke were identified. Only those with IPH who were referred for MR examination in the setting of acute stroke within 6 hours after symptoms onset and who had a CT-scan within the first 7 days confirming the diagnosis of IVH, without any clinical change or brain surgery, were included. Among the 205 patients considered, only
Results
Twenty-two patients with IPH, eleven of them with IVH, were retrospectively studied. There were 18 males and 4 females patients ranging in age from 51 and 89 years (mean age, 69 years). Sixteen cases involved arterial hypertension; one, arteriovenous malformation; one, low platelets; and four, unknown etiology.
The accuracy of MR for identifying hyperacute IVH is shown in Table 1, Table 2. The results of imaging findings of IVH, analyzing pattern and signal intensitity , are summarized in Table 3
Discussion
In analogy to subarachnoid hemorrhage (SAH), fresh intraventricular blood degrades more slowly than coexisting intraparenchymal hematoma because dilution by CSF and higher local oxygen content [6]. Therefore, recognition of IVH has prognostic value and may help to select patients for interventional therapy to avoid obstructive hydrocephalus. There are only a few studies on MR imaging of hyperacute intraventricular hemorrhage. Bakshi was the first to analyze the MR features of IVH, to describe
Conclusion
MRI seems to be diagnostic in the evaluation of hyperacute intraventricular hemorrhage as a complication of a deep intraparenchymal hematoma and may be of use as a primary diagnostic tool in stroke patient. FSE-FLAIR best performed for detection of clotted and layered hemorrhage and b1000 SE-DWI for quantification. EPI-GRE-T2* significantly underestimated the extent of bleeding when compared to CT. b0 images could not replace GRE images for the detection of acute blood products.
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