Intracranial hemorrhage made easy – a semiological approach on CT and MRI

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2014

Poster Number:

C-1120

Type:

Educational Exhibit

Keywords:

Neuroradiology brain, Emergency, MR physics, MR-Angiography, MR-Diffusion/Perfusion, CT-Angiography, Diagnostic procedure, Localisation, Staging, Haemorrhage, Acute, Education and training

Authors:

C. Scheau¹, A. E. Ghergus¹, G. Popa¹, E. M. Preda¹, R. A. Capsa², I. G. Lupescu¹; ¹Bucharest/RO, ²Bucuresti/RO

DOI:

10.1594/ecr2014/C-1120

DOI-Link:

https://dx.doi.org/10.1594/ecr2014/C-1120

Fig. 1: Biochemistry of bleeding. Evolution of a typical cerebral hematoma.

Fig. 7: MRI appearance of ageing blood in routine sequences.

Fig. 6: CT appearance of ageing blood. Several factors which vary depending on the...

Fig. 12: Frequency of bleeding sites in the brain (adaptation after Scarabino T et al. ...

Fig. 8: Acute stage hematoma. CT scan shows hyperdense hematoma in the right thalamic...

Learning objectives

To depict the basic CT and MRI semiology of intracranial hemorrhage (ICH). To know how to identify the presence and age of bleeding. To present the main etiologies of ICH depending on patient age, bioclinical predisposition or concurring pathology.

Background

Compartments of intracranial bleeding: A. Intraaxial (=Intraparenchymal) B. Extraaxial: - Subdural or epidural - Subarachnoid - Intraventricular Chronology of bleeding: –Hyperacute: < 12 hrs of evolution –Acute: 12 hrs to 72 hrs of evolution –Early subacute:3 days to 7 days of evolution –Late subacute:7 days to 1 month –Chronic: > 1 month * some authors consider a hyperacute hemorrhage up to 24 hrs, acute between 1 day and 3 days, early subacute up to 7 days, late subacute between 7 and 14 days [1]. Pathology...

Findings and procedure details

Image acquisition protocols: Routine head CT often requires additional spiral aquisitions in trauma, or when angio-CT is employed (detection of cerebral aneurysms or vascular malformations). Recommended acquisition parameters for routine head CT on a Siemens Somatom 16: sequential (axial) scan: 120 kV, effective mAs 400, rotation time = 1s, detector acqusition/collimation : 8x1,2, slice thickness 4,8 mm (recon: 2,4 mm), Kernel H31s. Spiral (helical) scan using fine detectors (16x0.6), rotation time = 1s, pitch = 0.85 slice thickness up to 1 mm for trauma/Angio-CT The...

Conclusion

CT is useful in evaluating recent intracranial hemorrhages, but MR is more sensitive especiallyin the subacute and chronic stages of bleeding and can provide superior information regarding the age, location, vessels status, and posible complications associated with ICH. Important discriminants in the correct diagnosis of an ICH are the location, etiology and bleeding age. Knowledge of ICH semiology in CT and MRI leads to a correct diagnosis, especially when presented as an acute neurological emergency.

Personal information

Cristian Scheau [email protected] Prof. Ioana Lupescu, MD, PhD, [email protected] Fundeni Clinical Institute, Department of Radiology, Medical Imaging and Interventional Radiology “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania

References

Bradley WG et al. Vascular Top 100 diagnosis.Amirsys,2003, 96-98 P. Slon, J. Etxano Cantera, G. Viteri, I. Simon Yarza, M. Páramo, R. Zalazar, P. Domínguez, M. R. Garcia de Eulate, J. L. ZUBIETA, Imaging of Intracranial Hemorrhage in Adults, doi: 10.1594/ecr2013/C-1397 M Yasser Metwally TEXTBOOK OF NEUROIMAGING (online version http://yassermetwally.com/) Reimer P, Parizel PM, Stichnoth FA. Clinical MR Imaging. Springer, 2003, 65-76. Jitendra L Ashtekar,L Gill Naul, Intracranial Hemorrhage Evaluation with MRI, Medscape Reference, http://emedicine.medscape.com/article/344973 Smith EE, Rosand J, Greenberg SM. Imaging of hemorrhagic stroke....