Hemorrhage on MRI

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The imaging characteristics of blood on MRI can be variable and change with the age of the blood.

In general, five stagesof haematoma evolution are recognised:

hyperacute
- intracellular oxyhaemoglobin
- isointense on T1
- isointense to hyperintense on T2
acute (1 to 2 days)
- intracellular deoxyhaemoglobin
- T2 signal intensity drops (T2 shortening)
- T1 remains intermediate-to-low
early subacute (2 to 7 days)
- intracellular methaemoglobin
- T1 signal gradually increases (T1 shortening) to become hyperintense
late subacute (7 to 14-28 days)
- extracellular methaemoglobin: over the next few weeks, as cells break down, extracellular methaemoglobin leads to an increase in T2 signal
chronic (>14-28 days)
- periphery
  - intracellular haemosiderin
  - low on both T1 and T2
- center
  - extracellular ~~hemichromes~~haemichromes
  - isointense on T1, hyperintense on T2

Practical points

extracranial blood products age differently ~~than~~from intracranial blood products, and extracranial haematomas often have a heterogeneous appearance, confounding attempts at reliably dating the age of an extracranial haemorrhage ^3,4
blood ~~/ haemorrhage~~/haemorrhage appears hypointense and blooms black on MRI T2*
GRE imaging is also highly sensitive to old haemorrhage and is seen as haemosiderin staining

~~-<li>extracellular hemichromes</li>~~
+<li>extracellular haemichromes</li>
-<li>extracranial blood products age differently than intracranial blood products, and extracranial haematomas often have a heterogeneous appearance, confounding attempts at reliably dating the age of an extracranial haemorrhage <sup>3,4</sup>
+<li>extracranial blood products age differently from intracranial blood products, and extracranial haematomas often have a heterogeneous appearance, confounding attempts at reliably dating the age of an extracranial haemorrhage <sup>3,4</sup>
~~-<li>blood / haemorrhage appears hypointense and blooms black on MRI T2*</li>~~
+<li>blood/haemorrhage appears hypointense and blooms black on MRI T2*</li>

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Hemorrhage on MRI

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