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Multicenter Study
. 2023 Jun;33(6):4158-4166.
doi: 10.1007/s00330-022-09366-2. Epub 2023 Jan 5.

Magnetic susceptibility as a 1-year predictor of outcome in familial cerebral cavernous malformations: a pilot study

Irene Incerti  1 , Massimo Fusco  2 , Valeria Elisa Contarino  3 , Silvia Siggillino  1 , Giorgio Conte  1   4 , Silvia Lanfranconi  5 , Giulio Andrea Bertani  6 , Chiara Gaudino  1   7 , Piergiorgio d'Orio  8 , Roberto Pallini  9 , Quintino Giorgio D'Alessandris  9 , Jennifer Marie Theresia Anna Meessen  10 , Enrico Bjorn Nicolis  10 , Antonella Vasamì  10 , Elisabetta Dejana  11 , Anna Maria Bianchi  12 , Fabio Maria Triulzi  1   4 , Roberto Latini  10 , Elisa Scola  1   13
Affiliations
Multicenter Study

Magnetic susceptibility as a 1-year predictor of outcome in familial cerebral cavernous malformations: a pilot study

Irene Incerti et al. Eur Radiol. 2023 Jun.

Abstract

Objectives: To test whether quantitative susceptibility mapping (QSM) of cerebral cavernous malformations (CCMs) assessed at baseline may predict the presence or absence of haemorrhagic signs at 1-year follow-up.

Methods: Familial CCM patients were enrolled in the longitudinal multicentre study Treat-CCM. The 3-T MRI scan allowed performing a semi-automatic segmentation of CCMs and computing the maximum susceptibility in each segmented CCM (QSMmax) at baseline. CCMs were classified as haemorrhagic and non-haemorrhagic at baseline and then subclassified according to the 1-year (t1) evolution. Between-group differences were tested, and the diagnostic accuracy of QSMmax in predicting the presence or absence of haemorrhagic signs in CCMs was calculated with ROC analyses.

Results: Thirty-three patients were included in the analysis, and a total of 1126 CCMs were segmented. QSMmax was higher in haemorrhagic CCMs than in non-haemorrhagic CCMs (p < 0.001). In haemorrhagic CCMs at baseline, the accuracy of QSMmax in differentiating CCMs that were still haemorrhagic from CCMs that recovered from haemorrhage at t1 calculated as area under the curve (AUC) was 0.78 with sensitivity 62.69%, specificity 82.35%, positive predictive value (PPV) 93.3% and negative predictive value (NPV) 35.9% (QSMmax cut-off ≥ 1462.95 ppb). In non-haemorrhagic CCMs at baseline, AUC was 0.91 in differentiating CCMs that bled at t1 from stable CCMs with sensitivity 100%, specificity 81.9%, PPV 5.1%, and NPV 100% (QSMmax cut-off ≥ 776.29 ppb).

Conclusions: The QSMmax in CCMs at baseline showed high accuracy in predicting the presence or absence of haemorrhagic signs at 1-year follow-up. Further effort is required to test the role of QSM in follow-up assessment and therapeutic trials in multicentre CCM studies.

Key points: • QSM in semi-automatically segmented CCM was feasible. • The maximum magnetic susceptibility in a single CCM at baseline may predict the presence or absence of haemorrhagic signs at 1-year follow-up. • Multicentric studies are needed to enforce the role of QSM in predicting the CCMs' haemorrhagic evolution in patients affected by familial and sporadic forms.

Keywords: Cerebral cavernous malformation; Haemorrhage; Magnetic susceptibility; Quantitative susceptibility mapping.

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References

    1. Zafar A, Quadri SA, Farooqui M et al (2019) Familial cerebral cavernous malformations. Stroke 50(5):1294–1301. https://doi.org/10.1161/STROKEAHA.118.022314 - DOI - PubMed - PMC
    1. Flemming KD, Graff-Radford J, Aakre J et al (2017) Population-based prevalence of cerebral cavernous malformations in older adults: Mayo Clinic Study of Aging. JAMA Neurology 74(7):801–805. https://doi.org/10.1001/jamaneurol.2017.0439 - DOI - PubMed - PMC
    1. Li W, Shenkar R, Detter MR et al (2021) Propranolol inhibits cavernous vascular malformations by β1 adrenergic receptor antagonism in animal models. J Clin Invest 131(3):e144893. https://doi.org/10.1172/JCI144893 - DOI - PubMed - PMC
    1. Oldenburg J, Malinverno M, Globisch MA et al (2021) Propranolol reduces the development of lesions and rescues barrier function in cerebral cavernous malformations: a preclinical study. Stroke 52(4):1418–1427. https://doi.org/10.1161/STROKEAHA.120.029676 - DOI - PubMed
    1. Berti I, Marchetti F, Skabar A et al (2014) Propranolol for cerebral cavernous angiomatosis: a magic bullet. Clin Pediatr 53(2):189–190. https://doi.org/10.1177/0009922813492885 - DOI

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