Detection of hyperacute subarachnoid hemorrhage of the brain by using magnetic resonance imaging

Object. The purpose of this study was to determine the diagnostic accuracy of high-field (1.5-tesla) magnetic resonance (MR) imaging in the assessment of hyperacute (< 12 hours after onset of symptoms) subarachnoid hemorrhage (SAH). Methods. This investigation included 13 patients who were examined 2 to 12 hours posthemorrhage by using an MR imaging protocol consisting of T-2-weighted and proton-density (PD)-weighted images, T-1-weighted images, fast echo-planar-diffusion-weighted (EP-DW) images, and fluid-attenuated inversion-recovery (FLAIR) images. Subarachnoid hemorrhage had been diagnosed using computerized tomography (CT) scanning in all cases. In all 13 cases, SAH was reliably detected on both PD-weighted and FLAIR images. In contrast with FLAIR studies, the PD-weighted images were free of cerebrospinal fluid flow artifacts. The SAH was detected on T-1-weighted images in only two cases and could not be detected on any T-2-weighted or EP-DW images. Conclusions. Even hyperacute SAH can be diagnosed reliably from high-field MR images obtained using PD-weighted or FLAIR sequences. Use of these sequences in an emergency MR protocol may preclude the need for additional CT studies to rule out SAH.