Detection of intracranial hemorrhage with susceptibility-weighted MR sequences

BACKGROUND AND PURPOSE: Detection of hemorrhage is important in the diagnos is and management of a variety of intracranial diseases. We evaluated the s ensitivity of the following sequences for depicting chronic hemorrhagic foc i associated with susceptibility dephasing: gradient-recalled echo (GRE) im aging, ORE-type single-shot echo-planar imaging (GRE-EPI), spin-echo-type s ingle-shot echo-planar imaging (SE-EPI), turbo spin-echo (TSE) imaging, hal f-Fourier single-shot turbo spin-echo (HASTE) imaging, and segmented HASTE (s-HASTE) imaging. To our knowledge, no previous comparison has been made w ith these techniques in the same patient. METHODS: Fifty patients with suspected chronic hemorrhage were examined pro spectively with the above six sequences. Contrast-to-noise ratio (CNR), sen sitivity to detection of lesions, conspicuity of internal architecture, and sensitivity to small hemorrhagic foci were evaluated. RESULTS: Hemorrhagic foci were found in 35 patients. The CNR of the GRE, OR E-EPI, SE-EPI, TSE, s-HASTE, and HASTE sequences was 30.9, 23.7, 3.6, 6.1, -29.3, and -13.1, respectively; the number of small hemorrhagic foci detect ed was 85, 96, 44, 22, two, and one, respectively, for the supratentorial w hite matter; 70, 40, 19, four, zero, and zero, respectively, for the suprat entorial cortical/subcortical region; and 73, 50, 26, 37, zero, and zero, r espectively, for the infratentorial/skull-base region. CONCLUSION: The GRE sequence was best for detecting susceptibility dephasin g associated with chronic intracranial hemorrhage. GRE-EPI, while comparabl e to GRE in the supratentorial compartment, was reduced in its sensitivity near the skull base, and may be used as an alternative to ORE in uncooperat ive, unsedated, pediatric, or claustrophobic patients. SE-EPI should not be used in screening for intracranial hemorrhage.