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Research ArticleBrain

Hemorrhage Detected Using MR Imaging in the Setting of Acute Stroke: An In Vivo Model

John Perl, Jean A. Tkach, Martin Porras-Jimenez, Michael Lieber, Nancy Obuchowski, Jeffrey S. Ross, Xia Ping Ding, Paul M Ruggieri, David M. Shearer, Kaveh Khajavi and Thomas J. Masaryk
American Journal of Neuroradiology November 1999, 20 (10) 1863-1870;
John Perl II
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Jean A. Tkach
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Martin Porras-Jimenez
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Michael Lieber
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Nancy Obuchowski
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Jeffrey S. Ross
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Xia Ping Ding
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Paul M Ruggieri
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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David M. Shearer
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Kaveh Khajavi
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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Thomas J. Masaryk
aFrom the Departments of Diagnostic Radiology (J.P., J.A.T., M.P-J., M.L., N.O., J.S.R., X.P.D., P.M.R., T.J.M.), Neurosurgery (D.M.S., K.K.), and Biostatistics (M.L., N.O.), Cleveland Clinic Foundation, Cleveland, OH.
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    fig 1.

    A–F, T1-weighted (A), SD-weighted (B), T2-weighted (C), FLAIR (D), and GRE (E) MR images and CT scan (F) of SAH at the level of the cervicomedullary junction in the same canine. Blood is seen on the MR images (obtained 2 hours after ictus) as an area of high signal obscuring the CSF-brain interface on the left (arrows). This is most conspicuous on the FLAIR image (D) and is not seen to any significant degree on the T2-weighted image (C) or the CT scan (F), performed 1 hour later.

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    fig 2.

    A–F, T1-weighted (A), SD-weighted (B), T2-weighted (C), FLAIR (D), and GRE (E) MR images and CT scan (F) of parenchymal hemorrhage within the right hemisphere in the same canine. All MR studies were performed 2 hours after ictus and show a focus of low-signal susceptibility artifact near the vertex, which, on the 3-hour CT scan, is found to be iatrogenically introduced gas (arrow). The T1-weighted image (A) does not show the parenchymal hemorrhage, whereas the SD-weighted image shows only vague loss of the gray/white junction (arrowhead, B). T2-weighted (C) and FLAIR (D) images display the heterogeneous hematoma with a ring of low signal (arrowhead) surrounded by vasogenic edema (open arrow). GRE image (E) prominently shows only heterogeneous susceptibility effect in the area of the hematoma (arrowhead), while CT scan shows the typical high-attenuation mass (F).

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    fig 3.

    Hyperacute parenchymal hemorrhage.

    A–C, T1-weighted (A), T2-weighted (B), and FLAIR (C) MR images obtained immediately after creation of parenchymal hemorrhage show a false-negative abnormality not detected by either reader.

    D–F, T1-weighted (D), T2-weighted (E), and FLAIR (F) MR images in the same animal 1 hour after creation of the hemorrhage show the obvious abnormality in the area of the corpus callosum, consistent with hyperacute parenchymal hemorrhage. All abnormalities were detected by both readers on all sequences.

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    TABLE 1:

    Diagnostic accuracy of MR imaging for detecting subarachnoid hemorrhage (SAH)

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    TABLE 2:

    Diagnostic accuracy of MR imaging for detecting parenchymal hemorrhage

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    TABLE 3:

    Diagnostic accuracy of CT for detecting SAH

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    TABLE 4:

    Diagnostic accuracy of CT for detecting parenchymal hemorrhage

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American Journal of Neuroradiology
Vol. 20, Issue 10
1 Nov 1999
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Cite this article
John Perl, Jean A. Tkach, Martin Porras-Jimenez, Michael Lieber, Nancy Obuchowski, Jeffrey S. Ross, Xia Ping Ding, Paul M Ruggieri, David M. Shearer, Kaveh Khajavi, Thomas J. Masaryk
Hemorrhage Detected Using MR Imaging in the Setting of Acute Stroke: An In Vivo Model
American Journal of Neuroradiology Nov 1999, 20 (10) 1863-1870;

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Hemorrhage Detected Using MR Imaging in the Setting of Acute Stroke: An In Vivo Model
John Perl, Jean A. Tkach, Martin Porras-Jimenez, Michael Lieber, Nancy Obuchowski, Jeffrey S. Ross, Xia Ping Ding, Paul M Ruggieri, David M. Shearer, Kaveh Khajavi, Thomas J. Masaryk
American Journal of Neuroradiology Nov 1999, 20 (10) 1863-1870;
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