A standardized MRI stroke protocol - Comparison with CT in hyperacute intracerebral hemorrhage

Background and Purpose-Diagnostic imaging in hyperacute ischemic stroke has been revolutionized by the introduction of diffusion- and perfusion-weight ed MRI (DWI and PWI). CT, however, is still needed to exclude intracerebral hemorrhage (ICH). The purpose of our study was to determine the diagnostic accuracy of a standardized, multimodal MRT (mMRI) stroke protocol in the q ualitative and quantitative assessment of hyperacute ICH (<6 hours). Methods-We investigated 9 patients with hyperacute ICH with CT followed imm ediately by a standardized mMRI stroke protocol (DWI, PWI [T2*-WI], FLAIR, T2-WI, and MRA). The time interval between MRT and symptom onset ranged fro m 3 hours to 5 hours 45 minutes. We analyzed and compared the size of the h ematoma on CT and all mMRI images by semiautomatic volumetry, Results-ICH was unambiguously identified on the basis of all mMRI sequences . With increasing susceptibility effect (T2*-WI), the ICH, appearing as an area of hyperintensity with central signal loss, became qualitatively most evident. Regarding quantitation, T2*-WI overestimated (median and mean diff erence, 18.9%/17.8%; SD sigma=24.4%) and DWI correlated best (median and me an difference, 3.97%/-4.36%; SD sigma=37.42%) with hematoma size on CT. Conclusions-Multimodal stroke MRI is as reliable as CT in the assessment of hyperacute ICH. Therefore, additional CT is no longer necessary to rule ou t ICH in hyperacute stroke. The use of mMRI alone in the diagnostic workup of a hyperacute stroke patient saves time and costs while rendering all the critical information needed to initiate an optimal treatment.