Abstract
A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on T2*-gradient recalled-echo or susceptibility-weighted sequences such as SWI and susceptibility-weighted angiography, which is not necessarily true. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or greater than that of CSF with variable amounts of hemosiderin staining along the neomembranes. We review the physiology and MR imaging physics behind the appearance of a chronic subdural hemorrhage, highlighting that the absence of a BBB can allow hemosiderin to be completely removed from the subdural compartment. Finally, we stress the importance of reviewing all multiplanar sequences for the presence of neomembranes, which can be quite subtle in the absence of hemosiderin staining and are critical for making the diagnosis of chronic subdural hemorrhage.
Highlights
One may reason that a chronic subdural hemorrhage should show blooming or hypointensity on T2*-gradient recalled-echo (GRE) or SWI, but this is not necessarily true.[1,2,3]
We present 5 infant survivors of abusive head trauma with subdural collections demonstrating intensity near that of CSF on T2*-GRE or hyperintensity on susceptibility-weighted angiography (SWAN) with variable amounts of hemosiderin staining
We provide a review of the physics and physiology relevant to the appearance of chronic subdural hemorrhage (SDH) on MR imaging and offer an explanation for the subdural fluid signal and variable hemosiderin staining on T2*GRE and SWI
Summary
One may reason that a chronic subdural hemorrhage (cSDH) should show blooming or hypointensity on T2*-GRE or SWI, but this is not necessarily true.[1,2,3] We present 5 infant survivors of abusive head trauma with subdural collections demonstrating intensity near that of CSF on T2*-GRE or hyperintensity on SWAN with variable amounts of hemosiderin staining. On SWAN, subdural compartment neomembranes with hemosiderin staining were seen bilaterally, compatible with cSDH. On MR imaging, the subdural fluid was slightly hyperintense to CSF on FLAIR and T1WI.
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