Top

Neuroradiology

Published in:

01-07-2012 | Diagnostic Neuroradiology

The value of magnetic resonance imaging for the detection of the bleeding source in non-traumatic intracerebral haemorrhages: a comparison with conventional digital subtraction angiography

Authors: Nina Lummel, Jürgen Lutz, Hartmut Brückmann, Jennifer Linn

Published in: Neuroradiology | Issue 7/2012

Abstract

Introduction

Conventional digital subtraction angiography (DSA) is currently regarded as the gold standard in detecting underlying vascular pathologies in patients with intracerebral haemorrhages (ICH). However, the use of magnetic resonance imaging (MRI) in the diagnostic workup of ICHs has considerably increased in recent years. Our aim was to evaluate the diagnostic accuracy and yield of MRI for the detection of the underlying aetiology in ICH patients.

Methods

Sixty-seven consecutive patients with an acute ICH who underwent MRI (including magnetic resonance angiography (MRA) and DSA during their diagnostic workup) were included in the study. Magnetic resonance images were retrospectively analysed by two independent neuroradiologists to determine the localisation and cause of the ICH. DSA was used as a reference standard.

Results

In seven patients (10.4%), a DSA-positive vascular aetiology was present (one aneurysm, four arteriovenous malformations, one dural arteriovenous fistula and one vasculitis). All of these cases were correctly diagnosed by both readers on MRI. In addition, MRI revealed the following probable bleeding causes in 39 of the 60 DSA-negative patients: cerebral amyloid angiopathy (17), cavernoma (9), arterial hypertension (8), haemorrhagic transformation of an ischaemic infarction (3) and malignant brain tumour with secondary ICH (2).

Conclusion

Performing MRI with MRA proved to be an accurate diagnostic tool in detecting vascular malformations in patients with ICH. In addition, MRI provided valuable information regarding DSA-negative ICH causes, and thus had a high diagnostic yield in ICH patients.

Available only for authorised users

Qureshi AI, Tuhrim S, Broderick JP et al (2001) Spontaneous intracerebral hemorrhage. NEJM N Engl J Med 344:1450–1460CrossRef

Foulkes MA, Wolf PA, Price TR et al (1988) The Stroke Data Bank: design, methods, and baseline characteristics. Stroke 19:547–554PubMedCrossRef

Linn J, Herms J, Dichgans M et al (2008) Subarachnoid hemosiderosis and superficial cortical hemosiderosis in cerebral amyloid angiopathy. AJNR Am J Neuroradiol 29:184–186PubMedCrossRef

(1999) Arteriovenous malformations of the brain in adults: the Arteriovenous Malformation Study Group. N Engl J Med 340:1812–1818

Kidwell CS, Chalela JA, Saver JL et al (2004) Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 292:1823–1830PubMedCrossRef

Fiebach JB, Schellinger PD, Gass A et al (2004) Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 35:502–506PubMedCrossRef

Kidwell CS, Wintermark M (2008) Imaging of intracranial haemorrhage. Lancet Neurol 7:256–267PubMedCrossRef

Broderick JP, Adams HP Jr, Barsan W et al (1999) Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 30:905–915PubMedCrossRef

Heiserman JE, Dean BL, Hodak JA et al (1994) Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 15:1401–1407PubMed

10.

Willinsky RA, Taylor SM, TerBrugge K et al (2003) Neurologic complications of cerebral angiography: prospective analysis of 2899 procedures and review of the literature. Radiology 227:522–528PubMedCrossRef

11.

Dawkins AA, Evans AL, Wattam J et al (2007) Complications of cerebral angiography: a prospective analysis of 2,924 consecutive procedures. Neuroradiology 49:753–759PubMedCrossRef

12.

Knudsen KA, Rosand J, Karluk D et al (2001) Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology 56:537–539PubMedCrossRef

13.

Fewel ME, Thompson BG Jr, Hoff JT (2003) Spontaneous intracerebral hemorrhage: a review. Neurosurg Focus 15:1–16

14.

Juvela S, Hillbom M, Palomaki H (1995) Risk factors for spontaneous intracerebral hemorrhage. Stroke 26:1558–1564PubMedCrossRef

15.

Thrift AG, McNeil JJ, Forbes A et al (1996) Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS) Group. Stroke 27:2020–2025PubMedCrossRef

16.

Brott T, Thalinger K, Hertzberg V (1986) Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 17:1078–1083PubMedCrossRef

17.

Gomori JM, Grossman RI, Hackney DB et al (1988) Variable appearances of subacute intracranial hematomas on high-field spin-echo MR. AJR Am J Roentgenol 150:171–178PubMed

18.

Viswanathan A, Chabriat H (2006) Cerebral microhemorrhage. Stroke 37:550–555PubMedCrossRef

19.

Al-Shahi R, Bhattacharya JJ, Currie DG et al (2003) Scottish Intracranial Vascular Malformation Study (SIVMS): evaluation of methods, ICD-10 coding, and potential sources of bias in a prospective, population-based cohort. Stroke 34:1156–1162PubMedCrossRef

20.

Cognard C, Gobin YP, Pierot L et al (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671–680PubMed

21.

Yeung R, Ahmad T, Aviv RI et al (2009) Comparison of CTA to DSA in determining the etiology of spontaneous ICH. Can J Neurol Sci 36:176–180PubMed

22.

Romero JM, Artunduaga M, Forero N et al (2009) Accuracy of CT angiography for the diagnosis of vascular abnormalities causing intraparenchymal hemorrhage in young patients. Emerg Radiol 16:195–201PubMedCrossRef

23.

Yoon DY, Chang SK, Choi CS et al (2009) Multidetector row CT angiography in spontaneous lobar intracerebral hemorrhage: a prospective comparison with conventional angiography. AJNR Am J Neuroradiol 30:962–967PubMedCrossRef

24.

Delgado Almandoz JE, Schaefer PW, Forero NP et al (2009) Diagnostic accuracy and yield of multidetector CT angiography in the evaluation of spontaneous intraparenchymal cerebral hemorrhage. AJNR Am J Neuroradiol 30:1213–1221PubMedCrossRef

25.

Hadizadeh DR, von Falkenhausen M, Gieseke J et al (2008) Cerebral arteriovenous malformation: Spetzler-Martin classification at subsecond-temporal-resolution four-dimensional MR angiography compared with that at DSA. Radiology 246:205–213PubMedCrossRef

26.

Unlu E, Temizoz O, Albayram S et al (2006) Contrast-enhanced MR 3D angiography in the assessment of brain AVMs. Eur J Radiol 60:367–378PubMedCrossRef

27.

Taschner CA, Gieseke J, Le Thuc V et al (2008) Intracranial arteriovenous malformation: time-resolved contrast-enhanced MR angiography with combination of parallel imaging, keyhole acquisition, and k-space sampling techniques at 1.5 T. Radiology 246:871–879PubMedCrossRef

28.

Ozsarlak O, Van Goethem JW, Maes M et al (2004) MR angiography of the intracranial vessels: technical aspects and clinical applications. Neuroradiology 46:955–972PubMedCrossRef

29.

Chen JC, Tsuruda JS, Halbach VV (1992) Suspected dural arteriovenous fistula: results with screening MR angiography in seven patients. Radiology 183:265–271PubMed

30.

Meckel S, Maier M, Ruiz DS et al (2007) MR angiography of dural arteriovenous fistulas: diagnosis and follow-up after treatment using a time-resolved 3D contrast-enhanced technique. AJNR Am J Neuroradiol 28:877–884PubMed

31.

Griffiths PD, Beveridge CJ, Gholkar A (1997) Angiography in non-traumatic brain haematoma. An analysis of 100 cases. Acta Radiol 38:797–802PubMed

32.

Toffol GJ, Biller J, Adams HP et al (1986) The predicted value of arteriography in nontraumatic intracerebral hemorrhage. Stroke 17:881–883PubMedCrossRef

33.

Laissy JP, Normand G, Monroc M et al (1991) Spontaneous intracerebral hematomas from vascular causes. Predictive value of CT compared with angiography. Neuroradiology 33:291–295PubMedCrossRef

34.

Linn J, Halpin A, Demaerel P et al (2009) Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurology 74:1346–1350CrossRef

35.

Greenberg SM, Briggs ME, Hyman BT et al (1996) Apolipoprotein E epsilon 4 is associated with the presence and earlier onset of hemorrhage in cerebral amyloid angiopathy. Stroke 27:1333–1337PubMedCrossRef

36.

van Rooden S, van der Grond J, van den Boom R et al (2009) Descriptive analysis of the Boston criteria applied to a Dutch-type cerebral amyloid angiopathy population. Stroke 40:3022–3027PubMedCrossRef

37.

Cooper AD, Campeau NG, Meissner I (2008) Susceptibility-weighted imaging in familial cerebral cavernous malformations. Neurology 71:382PubMedCrossRef

38.

de Souza JM, Domingues RC, Cruz LC et al (2008) Susceptibility-weighted imaging for the evaluation of patients with familial cerebral cavernous malformations: a comparison with t2-weighted fast spin-echo and gradient-echo sequences. AJNR Am J Neuroradiol 29:154–158PubMedCrossRef

39.

Lehnhardt FG, von Smekal U, Ruckriem B et al (2005) Value of gradient-echo magnetic resonance imaging in the diagnosis of familial cerebral cavernous malformation. Arch Neurol 62:653–658PubMedCrossRef

40.

Wijman CA, Venkatasubramanian C, Bruins S et al (2010) Utility of early MRI in the diagnosis and management of acute spontaneous intracerebral hemorrhage. Cerebrovasc Dis 30:456–463PubMedCrossRef

41.

Young N, Vladica P, Soo YS et al (1993) Acute intracerebral haematomas: assessment for possible underlying cause with MRI scanning. Australas Radiol 37:315–320PubMedCrossRef

42.

Dylewski DA, Demchuk AM, Morgenstern LB (2000) Utility of magnetic resonance imaging in acute intracerebral hemorrhage. J Neuroimaging 10:78–83PubMed

Title: The value of magnetic resonance imaging for the detection of the bleeding source in non-traumatic intracerebral haemorrhages: a comparison with conventional digital subtraction angiography
Authors: Nina Lummel
Jürgen Lutz
Hartmut Brückmann
Jennifer Linn
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 7/2012
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-011-0953-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The value of magnetic resonance imaging for the detection of the bleeding source in non-traumatic intracerebral haemorrhages: a comparison with conventional digital subtraction angiography

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2012

The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

Medial branch neurotomy in low back pain

European Society of Neuroradiology (ESNR)

Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms

Sino-orbital osteoma with osteoblastoma-like features: case reports

Angiographic CT with intravenous contrast agent application for monitoring of intracranial flow diverting stents