ABSTRACT
The most common cause of basal cerebral subarachnoid hemorrhage (SAH) is rupture of a cerebral artery aneurysm, but most reported series of SAH include cases where no aneurysm could be found. This would have no forensic relevance if all basal SAH would result from spontaneous ruptures of pathological blood vessels, but the situation is more complex because traumatic ruptures of otherwise normal cerebral arteries may be the only intracranial result of an injury. From the gross appearance, these two types of basal SAH cannot be distinguished. In victims with external injuries and in cases with doubtful circumstances, the detection and (histological) classification of the bleeding point(s) is necessary to distinguish between a spontaneous and traumatic origin of the rupture. We recommend post-mortem radiological examination of the cerebral arteries after instillation of a contrast medium. This method probably allows detection of even small bleeding points in the most inaccessible locations (not present in our actual series), and the radiological appearance of the bleeding points can also be helpful in the identification of the type of arterial alteration.
Subject(s)
Basilar Artery/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Adult , Aged , Aged, 80 and over , Barium Sulfate , Contrast Media , Diagnosis, Differential , Extravasation of Diagnostic and Therapeutic Materials , Female , Forensic Pathology , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Thrombosis/diagnostic imaging , Male , Middle Aged , Radiography , Rupture/diagnosis , Rupture, Spontaneous/diagnosisABSTRACT
OBJECTIVES: To investigate whether a magnetic resonance (MR) blood pool contrast agent enables both evaluation of myocardial perfusion and viability in nonreperfused infarction in pigs. MATERIALS AND METHODS: An optimized MR protocol using the blood pool contrast agent P792 (0.026 mmol/kg, twice the clinical dose, Guerbet, France) was investigated to evaluate nonreperfused myocardial infarction in an animal model. P792 was compared with the extracellular contrast agent Gd-DOTA (0.1 mmol/kg). The MRI findings were compared with histomorphometry performed with microspheres to evaluate perfusion and triphenyltetrazolium chloride (TTC) to evaluate viability. Contrast-enhanced MR imaging of the heart was performed on a 1.5-Tesla scanner 2 days after instrumentation in 6 minipigs. A saturation recovery steady-state free precession sequence was used for perfusion imaging and an inversion recovery fast low-angle shot sequence for evaluation of myocardial viability. RESULTS: P792 tended to depict areas of reduced perfusion more accurately than Gd-DOTA (17.2% +/- 11.1% versus 13.7% +/- 8.0%) in comparison to the gold standard of histomorphometry with microspheres (18.2% +/- 9.8%). Moreover, P792, but not Gd-DOTA, depicted ischemic areas for 30 minutes after intravenous injection. The change in myocardial signal intensity during first pass was not significantly different after P792 compared with Gd-DOTA (140.3% +/- 64.4% versus 123.3% +/- 22.5%, P = 0.56). P792 was highly accurate in depicting infarcted areas (11.1% +/- 7.1%) compared with Gd-DOTA (12.1% +/- 8.2%, r = 0.98, P < 0.001) and histomorphometry with TTC (12.2% +/- 8.0%, r = 0.99, P < 0.001). CONCLUSIONS: Unlike Gd-DOTA, the blood pool contrast agent P792 allows evaluation of myocardial perfusion for a period of 30 minutes and shows good agreement with histomorphometry. P792 must be examined in further studies to evaluate its potential in evaluating early myocardial lesions and reperfusion. In addition, P792 also allows for evaluation of myocardial viability.
