MRI of Cerebral Microhemorrhages

doi:10.2214/AJR.07.2249

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MRI of Cerebral Microhemorrhages

Marisa Kastoff Blitstein¹ and Glenn A. Tung¹

¹ Both authors: Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.

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Fig. 1A —76-year-old woman with congophilic amyloid angiopathy. Transaxial T2^*-weighted gradient-echo MR images show innumerable microhemorrhages predominantly at cerebral gray–white matter junction. Microhemorrhages are not present in basal ganglia, pons, or cerebellum. Large focal hemorrhages are present in left superior parietal lobe (arrows, A) and right inferior parietal lobe (arrow, B).

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Fig. 1B —76-year-old woman with congophilic amyloid angiopathy. Transaxial T2^*-weighted gradient-echo MR images show innumerable microhemorrhages predominantly at cerebral gray–white matter junction. Microhemorrhages are not present in basal ganglia, pons, or cerebellum. Large focal hemorrhages are present in left superior parietal lobe (arrows, A) and right inferior parietal lobe (arrow, B).

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Fig. 2A —71-year-old man with history of chronic hypertension, dementia, and multiple strokes who presented with new right-sided weakness. Transaxial T2^*-weighted gradient-echo MR image shows hemorrhage in left basal ganglia (solid arrow) and multiple microhemorrhages in left putamen (solid arrowhead), right caudate nucleus head (open arrow), and thalamus (open arrowhead).

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Fig. 2B —71-year-old man with history of chronic hypertension, dementia, and multiple strokes who presented with new right-sided weakness. Transaxial T2^*-weighted gradient-echo MR image shows microhemorrhage (arrowhead) in basis pontis and left peridentate cerebellum.

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Fig. 3A —14-year-old boy with postconcussive syndrome and microhemorrhages from diffuse axonal head injury. Unenhanced CT scan at presentation shows single punctuate hemorrhage in right frontal lobe and extensive scalp hematoma.

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Fig. 3B —14-year-old boy with postconcussive syndrome and microhemorrhages from diffuse axonal head injury. FLAIR (B) and T2^*-weighted gradient-echo (C) MR images obtained 6 months after A show bilateral corticomedullary microhemorrhages evident only on gradientecho MR images.

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Fig. 3C —14-year-old boy with postconcussive syndrome and microhemorrhages from diffuse axonal head injury. FLAIR (B) and T2^*-weighted gradient-echo (C) MR images obtained 6 months after A show bilateral corticomedullary microhemorrhages evident only on gradientecho MR images.

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Fig. 4 —23-year-old man with sickle cell trait and cerebral vasculitis secondary to meningococcal meningitis. Transaxial T2^*-weighted gradient-echo MR image shows numerous microhemorrhages and larger hemorrhages at corticomedullary junction.

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Fig. 5A —9-month-old girl with family history of cerebral cavernous malformation who presented with 1-month history of simple focal seizure. Transaxial T1-weighted (A) and T2^*-weighted (B) gradient-echo MR images show subacute hematoma (arrow, B) and vasogenic edema associated with right parietal cavernoma. In this child, multiple microhemorrhages on gradient-echo MRI are consistent with other smaller cavernous malformations (type 4 cerebral cavernous malformation).

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Fig. 5B —9-month-old girl with family history of cerebral cavernous malformation who presented with 1-month history of simple focal seizure. Transaxial T1-weighted (A) and T2^*-weighted (B) gradient-echo MR images show subacute hematoma (arrow, B) and vasogenic edema associated with right parietal cavernoma. In this child, multiple microhemorrhages on gradient-echo MRI are consistent with other smaller cavernous malformations (type 4 cerebral cavernous malformation).

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Fig. 6A —48-year-old man with hemorrhagic micrometastasis from renal cell carcinoma. Transaxial T2^*-weighted gradient-echo MR images show microhemorrhages in right frontal (arrowhead, A), left occipital (arrow, A), and left temporal (arrow, B) lobes.

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Fig. 6B —48-year-old man with hemorrhagic micrometastasis from renal cell carcinoma. Transaxial T2^*-weighted gradient-echo MR images show microhemorrhages in right frontal (arrowhead, A), left occipital (arrow, A), and left temporal (arrow, B) lobes.

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Fig. 6C —48-year-old man with hemorrhagic micrometastasis from renal cell carcinoma. Contrast-enhanced T1-weighted images show small enhancing foci consistent with hemorrhagic micrometastasis in right frontal (arrowhead, C), left occipital (arrow, C), and left temporal (arrow, D) lobes.

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Fig. 6D —48-year-old man with hemorrhagic micrometastasis from renal cell carcinoma. Contrast-enhanced T1-weighted images show small enhancing foci consistent with hemorrhagic micrometastasis in right frontal (arrowhead, C), left occipital (arrow, C), and left temporal (arrow, D) lobes.

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Fig. 7 —56-year-old man with biopsy-proven cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Transaxial T2^*-weighted gradient-echo MR image shows extensive confluent areas of high signal intensity in cerebral white matter, right frontal lobar hemorrhage (arrow), and single microhemorrhage (arrowhead) in right superior parietal lobe.

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Fig. 8 —62-year-old man with biopsy-proven cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Transaxial FLAIR MR image shows extensive and confluent areas of high signal intensity in cerebral white matter and three microhemorrhages.

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Fig. 9A —33-year-old man with Parry-Romberg syndrome (facial hemiatrophy). Transaxial FLAIR MR image shows skin and soft-tissue atrophy of left frontal scalp and multifocal areas of high signal intensity in white matter, confluent in left parietooccipital lobe, and ipsilateral to forehead hemiatrophy.

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Fig. 9B —33-year-old man with Parry-Romberg syndrome (facial hemiatrophy). Transaxial T2^*-weighted gradient-echo MR image shows scattered microhemorrhages in left frontal lobe, thalamus, and parietooccipital white matter.

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