Ageing blood on MRI

The imaging characteristics of blood on MRI are 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 hemichromes
      • isointense on T1, hyperintense on T2

Practical points

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

See also

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Article Information

rID: 6671
Section: Approach
Tags: mri, cases
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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    T2*
    Case 1: chronic
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    Case 2: subacute sudural haematoma
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    MRI of the brain ...
    Case 3: acute on chronic
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