Magnetic resonance imaging evaluation of cerebral cavernous malformations with susceptibility-weighted imaging

Abstract

Background: Cerebral cavernous malformations (CCMs) can be sporadic or inherited, the latter characterized by multiple lesions. Novel imaging sequences have increased the sensitivity of detecting multiple CCMs.

Objective: To compare T2-weighted gradient echo (T2*GRE) and susceptibility-weighted imaging (SWI) sequences in familial and sporadic CCM to assess their respective sensitivity.

Methods: This prospective study included 23 consecutive cases grouped as multifocal/familial CCMs (n=14), solitary/clustered sporadic CCMs with developmental venous anomaly (n=8), and postirradiation CCMs (n=1). Brain magnetic resonance imaging included T2*GRE and SWI sequences. Two radiologists independently counted the number of lesions on each sequence. The difference in the number of lesions on both sequences was compared, and interobserver agreement was evaluated.

Results: In multifocal/familial cases, a mean of 34.7 lesions were detected on T2*GRE and 66.9 on SWI (P=.001). The difference of lesion prevalence with the 2 techniques was significant (P=.006), with strong interobserver correlation for the T2*GRE sequence (P<.001) and SWI sequence (P<.001). Patients with solitary/clustered sporadic CCMs, including those associated with venous anomaly, had no difference in lesion prevalence in the 2 sequences.

Conclusion: SWI is more sensitive than T2*GRE in detecting CCM in multifocal/familial CCMs. Among cases classified as solitary/clustered with conventional imaging, including those associated with venous anomaly, the SWI did not impart additional sensitivity or reveal occult lesions not evident on T2*GRE sequence. No case was changed from the solitary/clustered to the multifocal clinical category because of SWI.