• Allen A Champagne, Yan Wen, Magdy Selim, Aristotelis Filippidis, Ajith J Thomas, Pascal Spincemaille, Yi Wang, and Salil Soman.
• Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.
• J Magn Reson Imaging. 2021 Dec 1; 54 (6): 1843-1854.

BackgroundThe perceived acuity of intracerebral hemorrhage (ICH) impacts the management of patients, both within emergent and outpatient/urgent settings. Morphology enabled dipole inversion (MEDI) quantitative susceptibility imaging (QSM) has improved characterization of ICH acuity, despite outstanding limitations in distinguishing blood products.Purpose/HypothesisUsing improved susceptibility quantification, novel postprocessing QSM method from multiecho complex total field inversion (mcTFI) may better discriminate between acute and subacute ICH, compared to MEDI.Study TypeRetrospective cohort study.SubjectsA total of 121 subjects enrolled following positive computerized tomography (CT) findings for ICH. Subjects were grouped based on time between admission and MR imaging: hyperacute (<24 hours), acute (1-3 days), early subacute (3-7 days), and late subacute (7-18 days).Field Strength/SequenceA multiecho gradient echo sequence at 3.0 T was paired with clinical noncontrast CT imaging.AssessmentA quantitative index (CTindex ) was derived based on relative intensities of blood on noncontrast CT. All images were co-registered, from which QSM parameters within the ICH area were assessed across groups, as well as the correlation with CTindex .Statistical TestsGroup differences were assessed using ANOVAs. Linear regressions between the CTindex , MEDI, and mcTFI measurements were used to assess their relationships. Statistical significance was set at P < 0.05.ResultsA total of 21 hyperacute, 72 acute, 21 early subacute, and 7 late-subacute patients were included in this analysis. Significant changes in blood susceptibility were found over time for the MEDI and mcTFI, although mcTFI better differentiated the hyperacute/acute from subacute stages. CTindex values within the ICH were more strongly correlated with mcTFI QSM (r = 0.727) than MEDI (r = 0.412) QSM.Data ConclusionMcTFI susceptibility estimation demonstrated better correlation with ICH acuity as suggested by CT, providing an improved method to assess acuity of intracranial blood products in clinical settings to identify cases that may require acute intervention.Level Of Evidence4 TECHNICAL EFFICACY STAGE: 2.© 2021 International Society for Magnetic Resonance in Medicine.

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