Role of T2*-weighted gradient echo MRI in the differential diagnosis of spontaneous intracerebral hemorrhage

In four patients presenting with acute nontraumatic intracerebral or intras pinal hemorrhage,T2*-weighted gradient-echo MRI showed numerous residual he mosiderin deposits due to old intracerebral hemorrhages that were missed on initial CT and spin-echo MRI. The demonstration of additional chronic blee dings and their anatomical distribution provided important diagnostic infor mation. In a hypertensive patient,the hemosiderin deposits were most pronou nced within deep brain structures suggesting hypertensive cerebral microang iopathy. In a second patient,the cortico-subcortical distribution of the he morrhages was typical of cerebral amyloid angiopathy. In a third patient, t he diffuse distribution including spinal bleeding,the marked calcification, and the characteristic appearance on spin-echo MRI were consistent with mu ltiple cavernomas. In another patient with cerebral and spinal hemorrhage,T 2*-weighted gradient echo MRI revealed new subclinical hemorrhages during f ollow-up. Based on these findings, we recommend that T2*-weighted gradient- echo MRI of the brain should be performed in all patients with acute intrac ranial and spinal bleedings.