Long-term visibility of primary intracerebral hemorrhage on magnetic resonance imaging.
BACKGROUND
It is unclear whether primary intracerebral hemorrhage (PICH) remains detectable with magnetic resonance imaging (MRI) in the long term, or whether a gradient echo recalled (GRE) sequence is always necessary to detect it.


METHODS
In a prospectively collected cohort of patients with stroke, we identified survivors of PICH able to undergo MRI at least 3 months after the original PICH. We compared several MRI sequences (spin echo (SE) T2, fast SE (FSE) T2 and proton density, fluid-attenuated inversion recovery, GRE) in a blinded fashion. The number of PICHs visible on each MRI sequence, and the presence of infarcts and microhemorrhages, were determined.


RESULTS
In 26 patients imaged 3 years (median) after PICH, between 61% (fluid-attenuated inversion recovery) and 100% (GRE) of PICHs remained identifiable as definite PICH. On FSE T2, 3.4% of PICHs were missed. There were no specific patient features that determined which PICHs remained visible. A new PICH developed in 29% of patients between original presentation and the current study, and 38% had microhemorrhages.


CONCLUSIONS
Although a FSE T2 sequence will identify most old PICHs, a GRE sequence is essential for definite identification. Recurrent PICH and microhemorrhages appear to be common.
Dimigen
Marion
M
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom.
Keir
Sarah
S
Dennis
Martin
M
Wardlaw
Joanna
J