Imaging of Acute Subarachnoid Hemorrhage with a Fluid-Attenuated Inversion Recovery Sequence in an Animal Model: Comparison with Non–Contrast-Enhanced CT

Abstract

BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery (FLAIR) MR imaging sequences have been previously described in the evaluation of acute subarachnoid hemorrhage (SAH) in human subjects and have demonstrated good sensitivity. The purpose of this study was to evaluate a FLAIR sequence in an animal model of SAH and to compare the results with those obtained with non–contrast-enhanced CT.

METHODS: SAH was experimentally induced in 18 New Zealand rabbits by injecting autologous arterial blood into the subarachnoid space of the foramen magnum. Nine animals had high-volume (1–2 mL) injections, and nine animals had low-volume (0.2–0.5 mL) injections. Four control animals were injected with 0.5 mL of saline. The animals were imaged with a FLAIR sequence and standard CT 2–5 hours after injection. Gross pathologic evaluation of seven of the animals was performed. Four blinded readers independently evaluated the CT and FLAIR images for SAH and graded the probability of SAH on a scale of 1 to 5 (1 = no hemorrhage, 5 = definite hemorrhage).

RESULTS: Overall, the sensitivity of FLAIR was 89%, and the sensitivity of CT was 39% (P < .01). In animals with a high volume of SAH, the sensitivity of FLAIR was 100%, and the sensitivity of CT was 56%. In animals with a low volume of SAH, the sensitivity of FLAIR was 78%, and the sensitivity of CT was 22%. The specificity of FLAIR in animals without SAH was 100%, and the specificity of CT was 100%. The average reader score for FLAIR was 3.8, and that for CT was 2.2 (P < .001). Reader scores for FLAIR were higher than those for CT in 94% (P < .01) of animals with SAH and in 25% of animals without SAH (P > .05). Seven animals underwent gross pathologic examination, and all had blood in the subarachnoid space around the brain stem.

CONCLUSION: FLAIR was more sensitive than CT in the evaluation of acute SAH in this model, especially when a high volume of SAH was present. This study provides a model for further experimentation with MR imaging in the evaluation of SAH. These findings are consistent with those of current clinical literature, which show FLAIR to be an accurate MR sequence in the diagnosis of SAH.