Abstract
The differentiation of solitary intra-axial hematomas from hemorrhagic neoplasms based on their magnetic resonance imaging (MRI) features is challenging. The treatment and prognosis for these two disease entities are vastly different and distinction between them is often based on MRI findings alone. The aim of this study was to describe the 1.5 tesla MRI features of canine intra-axial hematomas and correlate these findings with the evolution of hemorrhages described in human brains. Retrospective evaluation of patient details, clinical signs, and MRI findings of dogs with intra-axial hematomas that were histopathologically confirmed or determined via repeat MRI study and/or resolution of neurological signs. Ten dogs met the inclusion criteria. All 10 hematoma lesions were determined to be 2–7 days in age. On MRI, all 10 hemorrhagic lesions were comprised of two distinct regions; a relatively thin T1-weighted (T1W), T2-weighted (T2W) and gradient echo (GRE) hypointense (9/10) peripheral border region and a large central region that was heterogenous but predominantly T1W, T2W and GRE hyperintense (8/10). The peripheral border region was complete in its integrity in all 10 cases on T2W and GRE sequences. Contrast enhancement was present in (6/10) hematoma lesions and was always peripheral in nature with no evidence of central enhancement associated with any of the lesions. An intra-axial hematoma should be suspected in solitary hemorrhagic space occupying lesions that have a complete hypointense peripheral rim, elicit a peripheral contrast enhancement pattern, and display the expected temporal pattern of hematoma evolution.
Highlights
Intracranial hemorrhage is detected accurately with magnetic resonance imaging (MRI) in both human and veterinary medicine [1,2,3]
A wide range of pathologies can result in benign intracranial hemorrhage and subsequent hematoma formation, including: vasculitis [12], hypertension [13], degenerative disease [14], vascular malformations [15], hemorrhagic transformation of ischemic stroke [16], Angiostrongylus vasorum infection [17, 18], and coagulopathies [19]
Patient inclusion criteria were set as: (a) a complete brain MRI study was performed; (b) the MRI study confirmed a solitary hemorrhagic space-occupying intraaxial lesion, and subsequently; (c) there was histopathological confirmation of a benign hematoma, or a follow-up MRI that indicated resolution or marked improvement of the previous lesion with only supportive treatment, and/or the patients clinical signs resolved with only supportive treatment
Summary
Intracranial hemorrhage is detected accurately with magnetic resonance imaging (MRI) in both human and veterinary medicine [1,2,3]. MRI of Intracranial Intra-axial Hematomas (degree of oxygenation, blood-brain barrier integrity, local pH, hematocrit) [8]; and (c) technical factors (magnetic field strength, homogeneity of the magnetic field, spin echo and gradient echo sequence types) [9]. Despite the precision of MRI for detecting intracranial hemorrhage the complex appearance of hemorrhage means that determining the underlying pathology responsible for the disruption to vascular integrity can be challenging. This is encountered most frequently when trying to establish the nature of a solitary, intra-axial, hemorrhagic, space occupying lesion; does the lesion represent a hematoma or a hemorrhagic neoplastic mass? Management options for neoplastic hemorrhagic lesions include radiotherapy with or without concurrent surgical intervention, or palliative treatment. The prognosis for dogs suffering from intracranial neoplasia is guarded to poor with a previous study reporting a median survival time of 1 month [25], and euthanasia is frequently opted for in these cases
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