First-line investigation of acute intracerebral hemorrhage using dynamic magnetic resonance angiography.
OBJECTIVE
To report the initial experience of magnetic resonance (MR) digital subtraction angiography (MR-DSA) in the dynamic assessment of the cerebral circulation in acute non-traumatic intracerebral hemorrhage (ICH).


METHODS
Twelve patients with acute ICH were investigated within 6 days of the ictus using a dynamic contrast-enhanced 2-D MR angiogram that produces subtracted images with a temporal resolution of 1-2 frame/s. The MR-DSA examinations were assessed for evidence of an intracranial vascular abnormality and were compared with (i) the routine MR sequences, (ii) non-dynamic time-of-flight MR angiography, and (iii) catheter angiogram performed during the same admission.


RESULTS
All 12 MR-DSA examinations were considered to be technically satisfactory. MR-DSA detected an intracranial vascular abnormality in 7 patients (3 arteriovenous malformations, 2 aneurysms, 1 dural arteriovenous fistula, and 1 venous thrombosis). All abnormalities were confirmed by catheter angiography with the exception of one patient with venous sinus thrombosis found on MR imaging that did not undergo catheter angiography. All four arteriovenous shunts were detected by MR-DSA by virtue of early venous filling.


CONCLUSIONS
MR-DSA can be performed satisfactorily in the setting of acute ICH and provides an alternative method to catheter angiography for identifying shunting vascular abnormalities such as arteriovenous malformations and fistulae, as well as large aneurysms and venous occlusions. MR-DSA is a contrast-medium-based technique that does not suffer from the T1 shortening effects of acute hemorrhage that can obscure abnormalities on conventional flow-based non-dynamic techniques.
Evans
A L
AL
Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK. amlyn.evans@sth.nhs.uk
Coley
S C
SC
Wilkinson
I D
ID
Griffiths
P D
PD
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D001164:Arteriovenous Fistula / Q000175:diagnosis; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D002532:Intracranial Aneurysm / Q000175:diagnosis; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis
D003287:Contrast Media