MRI images of brain bleeding and cerebral infarction

The article was consulted with Specialist Doctor I Nguyen Thanh Hai - Radiologist - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International Hospital.

Cerebral hemorrhage and cerebral infarction are common cerebrovascular accidents in the elderly today. These two diseases are often confused with each other because of the similar symptoms. Therefore, MRI images in the diagnostic method of magnetic resonance imaging will help distinguish the two diseases from each other.

1.1 What is cerebral infarction? A cerebral infarction is the result of a sudden decrease in blood flow to the brain due to a total or partial blockage of a cerebral artery. Clinically, the patient had focal neurological symptoms, especially hemiplegia. Depending on the location of the injury, cerebral infarction will cause different symptoms such as visual disturbances, language disorders, coma, etc.
Causes of cerebral infarction may be due to pathological diseases. Pre-existing background such as hypertension, atherosclerosis, other cardiovascular diseases, metabolic disorders such as diabetes, dyslipidemia,... If blocked for a long time without developing If not done in time, the failure to supply enough blood to the brain will cause anemia, serious damage and even lead to brain cell necrosis due to lack of oxygen.
1.2 MRI images in cerebral infarction The MRI images for each type of cerebral infarction are as follows:
Cerebral infarction in the superficial branches: usually wedge-shaped, according to the cerebral perfusion zone of the artery. MRI images are used to differentiate with: Astrocytoma, brain contusion, encephalitis, brain edema due to brain tumor. Cerebral infarction in the watershed area: usually occurs due to hypotension, respiratory failure or heart failure, occlusion of an artery supplying the brain. Differentiate from multiple sclerosis Laxillary cerebral infarction: small image, in deep location and in central gray nuclei. The cause is often due to cerebral vasospasm, seen in hypertension, diabetes. Distinguished from the wide cavity Virchow – Robin. Cerebral infarction due to cerebral venous occlusion or venous sinus: Common in brain tumor, coagulopathy, infection,... Damage to both sides of the cerebral cortex, and not according to cerebral artery perfusion partition. Loss of flow signal in the venous sinuses. Thrombosis in the veins (rope sign) and in the venous sinuses (delta sign), is hyperintense on both T1 and T2 and is often associated with intracerebral hemorrhage. 1.3 MRI images in the stages of cerebral infarction Fulminant stage: 0-24 hours. The earliest signs of change appear on Perfusion, DWI. Only after 8 hours will the changes be clearly seen on T1 and T2 Stage: 1-7 days: Increased cerebral edema, maximum from 48-72 hours → strong mass effect. Areas of cerebral infarction on MRI are more obvious: T2 is increased and T1 is decreased. Cerebral haemorrhage over the infarcted area occurs within 24-48 hours, due to reperfusion, a "fog" sign due to hemoglobin breakdown. Subacute phase: 7-21 days. Decreased cerebral edema → reduced mass effect. Infarction area: T1 decreased and T2 increased. Chronic phase: > 21 days. Infarction area T1 decreased and T2 increased

2.1 What is a brain bleed? A bleeding in the brain, also known as a brain hemorrhage, occurs when blood escapes the vessel wall and enters the brain parenchyma. The rate of cerebral hemorrhage accounts for 20% of the cases of cerebrovascular accident. However, brain hemorrhage often has more serious consequences. The cause of brain bleeding is usually traumatic brain injury, high blood pressure, brain tumor, aneurysm,...
Brain bleeding can occur inside the brain at many different locations such as: the middle of the brain, between the mantle of the brain and the covering membrane, between the skull and the cerebral cortex. When the blood from the injury irritates the brain tissue, it leads to cerebral edema. The pooling of blood increases intracranial pressure on nearby brain tissue and reduces blood flow, from which cells cannot be nourished and will die.
2.2 MRI Imaging in Bleeding In order to diagnose bleeding in the brain, magnetic resonance angiography (MRI) of the blood vessels is important to detect treatable causes of hemorrhagic stroke. Magnetic resonance imaging can evaluate indicators such as:
Measure the volume of the hematoma Assess the compression in nearby structures Pushing the midline Displacement of the midline Image of brain recession Secondary brain lesions Hemor The brain is divided into 3 types and the specific MRI images are as follows:
Bleeding in the subarachnoid space: T1: sign of dirty CSF co-signs with brain tissue T2*: CSF is empty, FLAIR signal: Elevated CSF signal T2 : hypointensity due to hemosiderin deposition DWI: several foci of MRA hyperintensity: evaluation of cerebral aneurysm as one of the causes of subarachnoid hemorrhage. Intracerebral hematoma: T1, T2 signals change with hemoglobin breakdown. T2*: decreased at all stages. T1 + GD: subacute stage with increased signal border in the periphery for a few days, the purpose of distinguishing from brain tumor lesions, inflammation. Assess whether the lesion is still bleeding or not. MRA: assessment of vascular malformations MRV: evaluation of venous sinus thrombosis. The location and size of the hematoma suggest the cause of the cerebral hemorrhage. Bleeding in the ventricular system: T1: dirty cerebrospinal fluid in the ventricles Signal changes according to hemoglobin breakdown on T1 and T2 T2*: always hypointense. FLAIR: increased cerebrospinal fluid signal.

In summary, cerebral hemorrhage and cerebral infarction are types of cerebrovascular accident and are the main causes of death and disability for patients. Early diagnosis will help patients get timely intervention to reduce the risk of death and dangerous complications. Magnetic resonance imaging (MRI) is a commonly used technique in the diagnosis of cerebral infarction and cerebral hemorrhage. This is a diagnostic method that is easy to perform, gives quick and accurate results. Besides, MRI images help doctors determine the cause and have appropriate treatment.
Vinmec International General Hospital is equipped with modern machinery and equipment for medical examination and treatment in general and accurate and modern magnetic resonance imaging (MRI) for brain diseases and cerebral infarction in particular. .
For MRI scans, the hospital put into use a 3.0 Tesla magnetic resonance imaging machine with Silent technology for examination. The machine has the advantages of being especially beneficial for patients who are children, the elderly, people with weak health and people undergoing surgery. Limiting noise, creating comfort and reducing stress for customers during the shooting process, helping to capture better quality images and shorten shooting time. The machine uses modern technology to give the most accurate examination results.
The examination is always performed by a team of experienced and skilled doctors, so the hospital is always appreciated by international standard medical services.