Cerebral microhemorrhage with SWI dipole

Case contributed by Frank Gaillard


Incidental finding.

Patient Data

Age: 60 years
Gender: Male

A punctate focus of abnormal susceptibility within the anterior right frontal deep white matter demonstrates is difficult to identify on T1 and T2 weighted sequences and does not have surrounding vasogenic edema.

On phase images it demonstrates both black and white areas; the central areas is artefactually low due to aliasing whereas the superior and inferior dipoles correctly identify this lesion as being composed of blood product. 

Multiple punctate high T2 FLAIR foci within the supratentorial periventricular deep white matter are non-specific, but possibly secondary to chronic ischemic microangiopathy.

Case Discussion

Susceptibility-weighted imaging can be challenging to interpret due to heterogeneity of vendor preference and artefact, particularly alisaing. Identifying dipole signal change, best seen on coronal reconstructions, can be helpful. 

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