Neurographics

Imaging Spectrum of Brain Microhemorrhages on SWI

Chiang, F.; Tedesqui, G.; Mauricio Varon, D.; Wanderley, E.; Mamata, H.; Castillo, M.

View Article on Neurographics Website

Date of Activity Release: June 1, 2016
Date of Activity Expiration: June 1, 2019

Target Audience:
Intended for neuroradiologists and neuroradiology trainees with varying degrees of experience.

Learning Objectives:
To identify the distinctive imaging features on SWI of various pathologies, which may help in generating a differential diagnosis and in achieving a definite diagnosis.

Abstract
Microhemorrhages in cerebral and cerebellar parenchyma are due to various underlying causes. Conventional MR imaging sequences and CT are often not sufficient for their detection and determination of their distribution. SWI is a relatively new full-velocity‐compensated high-resolution 3-dimensional gradient echo sequence that accurately detects small hemorrhage (microhemorrhage) and calcification by exaggerating susceptibility signal intensity, which is more sensitive than T2 gradient echo. Increased availability of SWI has identified its utility in a wide range of other brain abnormalities. Here we presented and discussed various pathologies with brain microhemorrhages on SWI. We retrospectively reviewed cases with SWI. When available, we also compared the SWI with other MR imaging sequences and/or CT. SWI was particularly helpful for the detection and determination of distribution of microhemorrhages, which were more conspicuous than on CT or conventional MR imaging sequences. Some diseases had distinctive patterns of microhemorrhages as follows: in the deep subcortical white matter, posterior corpus callosum, and midbrain location for diffuse axonal injuries; cortical for amyloid angiopathy; peripheral in sickle cell disease; basal ganglia and cerebellar for hypertensive microhemorrhages; perivascular for invasive mucormycosis; and diffuse involvement in fat emboli. However, in some entities, the distribution of microhemorrhages was nonspecific, and, in these patients, clinical information and history were helpful in reaching a correct diagnosis.

Commercial Support
No commercial support was received for this activity.

Credit Designation Statement

The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Physician Participation:
Each participant will review the corresponding Neurographics article located at www.neurographics.org. Upon completion, each physician will complete and pass a post-test with a score of at least 80% to receive a CME certificate.

Disclosures:
All individuals in control of content have disclosed the following relevant financial relationships. All of these relationships were treated as a conflict of interest, and have been resolved (C7 SCS 6.1-6.2, 6.5)

Authors:
Authors have no relevant financial relationships.

Planners:

Name

Role

Relationship/Interest

Barton Branstetter 

Editor in Chief

None, N/A

Adam Flanders

Deputy Editor

Royalties, Lippincott Williams and Wilkins

Robert Quencer 

Consulting Editor

None, N/A

Mark Mullins

Associate Editor

Non-remunerative position, AUR6

Meng Law

Associate Editor

Stockholder, Clinical Imaging

Michele Johnson

Associate Editor

Consultant, Boston Scientific, Inc.

Edward Escott

Associate Editor

Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers

Scott Faro

Associate Editor

None, N/A

Tina Young Poussaint

Associate Editor

None, N/A

Dheeraj Ghandi

Associate Editor

Grant, Arstasis, Axera Inc.; Consultant, Covidien, EV3

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