Diffusion imaging and late sub acute brain hemorrhage (MR).

PROTOCOL:

T2W – Sagittal & axial scans
T1W – Axial scans
FLAIR – Coronal scans
DW & T2FFE (Gradient) – Axial scans
3D TOF MR angiography of the circle of Willis vessels and MIP reconstruction.
MR venography protocol

FINDINGS:

-Evidence of an area of altered signal is noted in the left basal ganglia measuring about 30 x 15 mm in diameters. It shows hyper intensity on T1; T2; Flair; gradient and diffusion images while it looks hypo intense on ADC maps images. In all previously mentioned sequences; it is surrounded by outer margin of hypo intensity with surrounded mild peri focal edema with mild indentation on the left lateral ventricle.
-Bilateral attenuation of the peripheral branches of both middle cerebral arteries

-The rest of the brain Parenchyma shows normal grey white matter differentiation and signal intensities.  No focal mass lesion is seen.
-Right lateral and third ventricles are normal in size and position. Septum is in midline.  There is no midline shift.
-Basal cisterns, cortical sulci and gyri are normal in appearance.
-Corpus callosum shows normal MR morphology.
-Brain stem and cerebellum show normal signal intensities.
-Fourth ventricle is normal in size and is midline in position.

-MR angiography reveals normal course, caliber and outlines of the remaining vessels. Vertebro basilar trunk is also patent.
-The superior sagittal sinus, straight sinus, bilateral transverse sinuses,  their confluence, bilateral sigmoid sinuses and parts of internal jugular vein visualized, show normal course, caliber and outlines. No obvious evidence of any venous sinus thrombosis is seen at present.

OPINION:
• Picture is suggestive of late sub acute hematoma in the left basal ganglia.
• It is considered late sub acute hematoma as it is seen with no blooming effect on gradient; restricted diffusion on diffusion and ADC maps images.