ROLE OF ADDITION OF NON-CONTRAST MRI SCAN BRAIN WITH SPECIFIC SEQUENCES (GRE, SWI, TOF ANGIOGRAM & TOF VENOGRAM SEQUENCES) TO ROUTINE NON-CONTRAST CT SCAN BRAIN AT INITIAL EMERGENCY WORK UP IN EVALUATION OF INTRA CEREBRAL HAEMORRHAGE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 16
Abstract
BACKGROUND The aim of the study is to assess the outcome of addition of non-contrast MRI scan brain with specific sequences (GRE, SWI, TOF Angiogram & TOF Venogram sequences) when compared to plain non-contrast CT scan brain at initial emergency work up in evaluation of intracerebral haemorrhage. Intraventricular haemorrhage, traumatic subarachnoid haemorrhage, diffuse axonal injury and haemorrhagic contusions. Causes of non-traumatic haemorrhage include hypertension, ruptured aneurysms, arteriovenous malformation (AVM), amyloid angiopathy, haemorrhagic transformation of ischemic infarction, venous haemorrhagic infarct secondary to cortical venous sinus thrombosis. The aim of the study is to assess the outcome of addition of non-contrast MRI scan brain with specific sequences (GRE, SWI, TOF Angiogram & TOF Venogram sequences) when compared to plain non-contrast CT scan brain at initial emergency work up in evaluation of intracerebral haemorrhage. MATERIALS AND METHODS This descriptive study spanned a course of 16 months (September 2016 to December 2017) which includes 90 patients with intracerebral haemorrhage on plain CT scan. These patients are subjected to MRI scan immediately as a part of emergency work up and the findings were recorded. RESULTS Out of 90 patients of our study 45 cases (50%) were traumatic haemorrhage, 18 cases (20%) were hypertensive haemorrhage, 15 were haemorrhage secondary to aneurysms (16.7%) and 4 cases due to arteriovenous malformations (4.4%) remaining 8 cases (8.9%) include haemorrhage secondary to amyloid angiopathy (3 cases), haemorrhagic metastasis (1 case) & haemorrhagic transformation of ischemic infarct (4 cases). Among 15 cases of haemorrhage secondary to aneurysms, the aneurysm is identified on MR TOF Angiogram sequence in 12 cases which is not evident on plain CT scan, in rest of the 3 cases the aneurysm is identified on further investigation with CT Angiogram. Among 4 cases of arteriovenous malformations, focal haemorrhage alone seen on CT scan which on MR show underlying nidus & AV malformation. Among 3 cases of amyloid angiopathy, the larger bleeds are seen on CT scan & micro-haemorrhages are identified only on MR scan thus aiding in diagnosis & management. No differences observed between MR and CT scan findings in cases of haemorrhagic metastasis (1 case) & haemorrhagic transformation of ischemic infarct (4 cases). Among 45 cases of traumatic haemorrhage 15 cases are categorized as diffuse axonal injury based on petechial haemorrhages at grey white matter junction which are appreciated on MR alone & not evident on CT scan. However, CT scan identified bony skull injuries better than MR scan. Among 18 cases of hypertensive haemorrhage no differences observed between MR and CT scan findings in 15 cases; in rest of the 3 cases, additional micro haemorrhages seen in pons & cerebellar hemispheres, however no significant alteration in diagnosis or management made. The percentage of subjects with diagnosis made by adding MRI to routine CT scan is calculated based on the data. Among total 90 patients, in 31 cases addition of MR resulted in obtaining the diagnosis. 3 cases are detected on further investigation (CT Angiogram) which were not identified on Plain CT & MR. In rest of the 56 patients, Plain CT scan alone proved enough for diagnosis as MR did not add any further findings. Thus in 34.4% of the subjects, diagnosis is made after addition of MRI to routine CT scan. CONCLUSION In cases of intracerebral haemorrhage, MRI added crucial information to CT scan and aided in identifying the cause of intracerebral haemorrhage, diagnosis and management.
Authors and Affiliations
Somasekhar R, Praveen Elaprolu
Keywords
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- EP ID EP414633
- DOI 10.14260/jemds/2018/449
- Views 50
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