Utility of Various Ultrafast Magnetic Resonance Sequences in the Detection of Fetal Intracranial Hemorrhage

Abstract

Objective: The aim of this study is to compare the images obtained from standard ultrafast magnetic resonance (MR) imaging sequences with gradient (GRE) sequence images in identifying fetal intracranial hemorrhage (ICH).

Materials and methods: MR images of fetal brains with ICH done between October 2012 and September 2015 were reviewed. The images obtained from four ultrafast MR sequences- Turbo Fast Low Angle Shot (Turbo FLASH) T1-weighted images, Half Fourier Acquisition single-shot turbo spin echo (HASTE) T2-weighted images, b0 images of diffusion-weighted imaging (DWI) and b800 images of DWI were compared with images obtained from GRE sequence in depicting fetal ICH.

Results: Out of the 212 fetuses during the study period, 15 fetuses had ICH. In the 15 fetuses with ICH as detected on GRE, Grade1 germinal matrix hemorrhage was seen in 5 fetuses, Grade 2 in 4 fetuses, Grade 3 in 3 fetuses, and Grade 4 in two fetuses. Subdural hemorrhage was seen in 1 fetus. In comparison to GRE sequence, b0 of DWI sequence was almost equal in the depiction of ICH. T2 HASTE sequence also delineated hemorrhage, although not as effectively as GRE and b0 images of images DWI. T1 Turbo FLASH and b800 images of DWI were less reliable in the depiction of fetal ICH but were useful in predicting the stage of hemorrhage.

Conclusion: As compared to GRE sequence, b0 images of DWI followed by HASTE are the two preferred ultrafast sequences in the diagnosis of fetal ICH.

Keywords: Fetus; germinal matrix hemorrhage; magnetic resonance imaging; ultrasound.

Figure 1

Line diagram illustrating the visibility of hemorrhage in GRE and other ultrafast sequences

Figure 2

Axial images of GRE (a and b), Half Fourier acquisition single shot turbo spin echo (c) and bo diffusion-weighted imaging (d) sequences showing grade1 intraparenchymal hemorrhages in bilateral frontal region (arrow). They are not visible in axial b800 diffusion-weighted imaging (e) and T1 TURBO FLASH axial images (f)

Figure 3

Axial images of GRE (a and b), Half Fourier acquisition single shot turbo spin echo (c), bo diffusion-weighted imaging (d) and T1 TURBO FLASH (f) sequences depicting grade 2 germinal matrix- intraventricular early subacute hemorrhage (arrow) on the right side. Thin rim of subarachnoid hemorrhage is seen in left frontal sulcal spaces (arrowhead) on GRE sequence. Less volume of hemorrhage (arrow) is depicted in axial b800 diffusion-weighted imaging images (e)

Figure 4

Axial images of GRE (a), Half Fourier acquisition single shot turbo spin echo (b and c), bo diffusion-weighted imaging (d), b800 diffusion-weighted imaging (e) and T1 TURBO FLASH (f) sequences showing Grade 3 late subacute hemorrhage (arrow)

Figure 5

Axial images of GRE (a and b), Half Fourier acquisition single shot turbo spin echo (c), bo diffusion-weighted imaging (d) and b800 diffusion-weighted imaging (e) sequences showing Grade 4 intracranial hemorrhage in left parietal region. It is not visible in T1 TURBO FLASH axial images (f). There is extension of hemorrhage into the ventricles, basal cisterns and sulcal spaces (arrowhead)