Imaging Diagnosis of Chronic Encapsulated Intracerebral Hematoma, a Comparison of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) characteristics

Abstract

SummaryBackgroundChronic encapsulated intracerebral hematoma (CEICH) is a rare type of intracerebral hematoma that is often misdiagnosed.To explore the characteristics of CEICH on computerized tomography (CT) and magnetic resonance imaging (MRI).Material/MethodsClinical, CT, MRI, and susceptibility weighted imaging (SWI) data of 5 patients who were diagnosed with CEICH on surgery and pathology were retrospectively analyzed.ResultsCT showed quasi-circular or elliptical lesions with clear borders in all 5 cases and iso-density or low-density in the center of lesions that were surrounded by peripheral edema in 2 cases. CT showed mass effect in 5 patients. On contrast-enhanced CT, 2 cases exhibited mild ring enhancement, and 3 cases exhibited moderate ring enhancement. MRI showed cystic lesions with high uniform signal on T1-weighted images (T1WI) and T2-weighted images (T2WI), a lowsignal ring sign on the coated cystic lesions on T2WI, a lower signal ring sign on SWI, and ring enhancement after administration of contrast.ConclusionsCT imaging of CEICH did not reveal any typical characteristics in the studied patients. MRI showed an envelope with a “ring” and intra-capsular bleeding features. MRI is an effective imaging modality for the diagnosis of CEICH.

Encapsulated Intracerebral Hematoma Presenting as Cerebral Abscess

“…The intracapsular bleeding showed varying degrees of T1 and T2 hyperintensity depending on chronicity. The study suggested that ring enhancement with intracapsular bleeding on MRI can be helpful in the diagnosis of CEIH [17].…”

MRI appearance of chronic subdural hematoma

“…Remarkably, with 62% of the cases, more than half of cSDH showed mass-like contrast enhancement, a finding that was also reported in 3 of 6 cases by Spreer et al and in 2 case reports by Nagasaka et al ( 6 , 21 ). Interestingly, ubiquitous mass-like contrast enhancement is not a typical finding of parenchymal hematomas, which rather show circumferential enhancement during organization and resorption ( 27 ). It is possible that mass-like contrast enhancement in cSDH is rather the result of contrast leakage via the inflammatory membranes into non-solid hematomas.…”

Chronic Encapsulated Intracerebral Hematoma as an Occasional Finding in Sudden Cardiac Death

“…The intracapsular bleeding can show different degrees of T1 and T2 hyperintensity depending on its chronicity. According to other studies [ 9 , 10 ], the ring enhancement with intracapsular bleeding on MRI can be very helpful in the diagnosis of CEIH. Treatment is based on surgical removal of the mass.…”

“…In a retrospective review of five patients, Cai et al (2017) described CT and MRI characteristics of CEIH. On CT imaging, CEIH was reported as almost circular or elliptical cystic lesions surrounded by an enhancement such as brain abscesses [ 9 ]. Unfortunately, these findings are not sufficient to confirm a diagnosis of CEIH.…”

“…Unfortunately, these findings are not sufficient to confirm a diagnosis of CEIH. On MRI, CEIH has been described as a lesion with avid ring enhancement and intracapsular bleeding [ 9 ]. The intracapsular bleeding can show different degrees of T1 and T2 hyperintensity depending on its chronicity.…”