Ageing blood on MRI

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

In general, five stages of haematoma evolution are recognised:

  1. hyperacute
    • intracellular oxyhaemoglobin
    • isointense on T1
    • isointense to hyperintense on T2
  2. acute (1 to 2 days)
    • intracellular deoxyhaemoglobin
    • T2 signal intensity drops (T2 shortening)
    • T1 remains intermediate-to-low
  3. early subacute (2 to 7 days)
    • intracellular methaemoglobin
    • T1 signal gradually increases (T1 shortening) to become hyperintense
  4. 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 
  5. chronic (>14-28 days)
    • periphery
      • intracellular haemosiderin
      • low on both T1 and T2
    • center
      • extracellular haemichromes
      • isointense on T1, hyperintense on T2

Practical points

  • 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 3,4
  • blood/haemorrhage appears hypointense and blooms black on MRI T2*
  • GRE imaging is also highly sensitive to old haemorrhage and is seen as haemosiderin staining

See also

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Article information

rID: 6671
Section: Approach
Tag: mri
Synonyms or Alternate Spellings:
  • Aging blood on MRI

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Cases and figures

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    Figure 1: sequence of ageing blood on MRI
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    Case 1: hyperacute
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    Figure 2: MRI and CT characteristics
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    Case 3: subacute sudural haematoma
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    MRI of the brain ...
    Case 4: acute on chronic
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    Case 5: chronic
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