Pitfalls in the imaging interpretation of intracranial hemorrhage

Publication date: Available online 3 August 2018Source: Seminars in Ultrasound, CT and MRIAuthor(s): Humberto MoralesAbstractIntracranial hemorrhage (ICH) is one of the most common pathologic findings in the emergent head computed tomography (CT) imaging. ICH presents as hyper-attenuation in parenchymal, subarachnoid, subdural or epidural location. However, the initial interpretation of areas of hyper-attenuation can be challenging as other pathologic or non-pathologic processes (e.g. calcifications, vascular malformations, highly cellular tumors, iodinated contrast or beam-hardening artifacts) can have similar appearance. ICH can also present as iso-attenuation on CT, being difficult to distinguish from the brain parenchyma. Dual-energy CT can separate hemorrhage from some other causes of hyper-attenuation. Albeit this type of technology has limited availability. Pitfalls on MR imaging are possible but less common. The characterization of hemorrhage on conventional MR sequences, and particularly on gradient recall echo (GRE) or susceptibility weighted imaging (SWAN) is improved. Thus, MRI is considered a problem-solving technique. Radiologists have a prominent role in the interpretation of an initial head CT; recognizing potential pitfalls or alternative diagnosis and if necessary recommending additional work-up. Key imaging findings and technical considerations in common and uncommon pitfalls of ICH are reviewed here.
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research