Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;33(1):138-146.
doi: 10.1111/jon.13054. Epub 2022 Sep 28.

Quantitative susceptibility mapping improves cerebral microbleed detection relative to susceptibility-weighted images

Kyuwon Lee  1 , Brian Ellison  1 , Magdy Selim  2 , Ngo H Long  3 , Aristotelis Filippidis  4 , Ajith J Thomas  5 , Pascal Spincemaille  6 , Yi Wang  6 , Salil Soman  1
Affiliations

Quantitative susceptibility mapping improves cerebral microbleed detection relative to susceptibility-weighted images

Kyuwon Lee et al. J Neuroimaging. 2023 Jan.

Abstract

Background and purpose: Cerebral microbleed (CMB) detection impacts disease diagnosis and management. Susceptibility-weighted imaging (SWI) MRI depictions of CMBs are used with phase images (SWIP) to distinguish blood from calcification, via qualitative intensity evaluation (bright/dark). However, the intensities depicted for a single lesion can vary within and across consecutive SWIP image planes, impairing the classification of findings as a CMB. We hypothesize that quantitative susceptibility mapping (QSM) MRI, which maps tissue susceptibility, demonstrates less in- and through-plane intensity variation, improving the clinician's ability to categorize a finding as a CMB.

Methods: Forty-eight patients with acute intracranial hemorrhage who received multi-echo gradient echo MRI used to generate both SWI/SWIP and morphology-enabled dipole inversion QSM images were enrolled. Five hundred and sixty lesions were visually classified as having homogeneous or heterogeneous in-plane and through-plane intensity by a neuroradiologist and two diagnostic radiology residents using published rating criteria. When available, brain CT scans were analyzed for calcification or acute hemorrhage. Relative risk (RR) ratios and confidence intervals (CIs) were calculated using a generalized linear model with log link and binary error.

Results: QSM showed unambiguous lesion signal intensity three times more frequently than SWIP (RR = 0.3235, 95% CI 0.2386-0.4386, p<.0001). The probability of QSM depicting homogeneous lesion intensity was three times greater than SWIP for small (RR = 0.3172, 95% CI 0.2382-0.4225, p<.0001), large (RR = 0.3431, 95% CI 0.2045-0.5758, p<.0001), lobar (RR = 0.3215, 95% CI 0.2151-0.4805, p<.0001), cerebellar (RR = 0.3215, 95% CI 0.2151-0.4805, p<.0001), brainstem (RR = 0.3100, 95% CI 0.1192-0.8061, p = .0163), and basal ganglia (RR = 0.3380, 95% CI 0.1980-0.5769, p<.0001) lesions.

Conclusions: QSM more consistently demonstrates interpretable lesion intensity compared to SWIP as used for distinguishing CMBs from calcification.

Keywords: MRI hemorrhage; brain calcifications; cerebral microbleed; quantitative susceptibility mapping; susceptibility-weighted imaging.

PubMed Disclaimer

References

REFERENCES

    1. Greenberg SM, Vernooij MW, Cordonnier C, et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol 2009;8:165-74.
    1. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013;12:822-38.
    1. Chesebro AG, Amarante E, Lao PJ, Meier IB, Mayeux R, Brickman AM. Automated detection of cerebral microbleeds on T2*-weighted MRI. Sci Rep 2021;11:4004.
    1. Pétrault M, Casolla B, Ouk T, Cordonnier C, Bérézowski V. Cerebral microbleeds: beyond the macroscope. Int J Stroke 2019;14:468-75.
    1. Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility-weighted imaging: technical aspects and clinical applications, part 2. AJNR Am J Neuroradiol 2009;30:232-52.

Publication types

LinkOut - more resources