Fluid-attenuated inversion-recovery MR imaging in acute and subacute cerebral intraventricular hemorrhage

BACKGROUND AND PURPOSE: Fluid-attenuated inversion-recovery (FLAIR) MR imag ing may show subarachnoid hemorrhage (SAH) with high sensitivity. We hypoth esized that the FLAIR technique is effective and reliable in the diagnosis of cerebral intraventricular hemorrhage (IVH). METHODS: Two observers evaluated the 1.5-T MR fast spin-echo FLAIR images, T1- and T2-weighted MR images, and CT scans of 13 patients with IVH and the FLAIR images of 40 control subjects. RESULTS: IVH appeared bright on the FLAIR images obtained during the first 48 hours and was of variable appearance at later stages. FLAIR MR imaging d etected 12 of 13 cases of IVH; no control subjects were falsely thought to have IVH (92% sensitivity, 100% specificity). However, IVH could not be ful ly excluded in the third ventricle (20%, n = 8) or in the fourth ventricle (28%, n = 11) on some control images because of CSF pulsation artifacts. Tw o cases had CT-negative IVH seen on FLAIR images, One case had FLAIR-negati ve IVH seen by CT. Although the sensitivities of conventional MR imaging (9 2%) and CT (85%) were also high, FLAIR imaging showed IVH more conspicuousl y than did standard MR imaging and CT in 62% of the cases (n = 8), FLAIR wa s as good as or better than CT in showing IVH in 10 cases (77%), FLAIR imag es showed all coexisting SAH. CONCLUSION: FLAIR MR imaging identifies acute and subacute IVH in the later al ventricles with high sensitivity and specificity. In cases of subacute I VH, conventional MR imaging complements FLAIR in detecting IVH, The usefuln ess of the FLAIR technique for detecting third anti fourth ventricular IVH may be compromised by artifacts, Blood hemoglobin degradation most likely c auses the variable FLAIR appearance of IVH after the first 48 hours.