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Silent cerebral microbleeds on T2*-weighted MRI: correlation with stroke subtype, stroke recurrence, and
Hiroyuki Kato1, Masahiro Izumiyama, Kimiaki Izumiyama
1Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan. katoh@mail.cc.tohoku.ac.jp
Background And Purpose:
Gradient-echo T2*-weighted MRI is uniquely sensitive to detect silent, old hemosiderin deposits, but the clinical significance of such "microbleeds" remains to be determined. Therefore, we investigated the incidence and the number of microbleeds among different stroke subtypes and the correlation with stroke recurrence and the severity of leukoaraiosis.
Methods:
This study consisted of 213 patients (73.5+/-9.1 years old, 104 men and 109 women), who were classified according to stroke subtypes into atherothrombotic infarction (24 patients), cardioembolic infarction (23 patients), lacunar infarction (66 patients), intracerebral hemorrhage (35 patients), and control (65 patients) groups. Gradient-echo T2*-weighted MRI was performed with a 1.5 T system, and asymptomatic microbleeds were located and counted.
Results:
The incidence and the number of microbleeds were significantly greater in patients with intracerebral hemorrhage (71.4% and 9.1+/-13.8, respectively) and lacunar infarction (62.1% and 7.4+/-16.1) compared with patients with cardioembolic infarction (30.4% and 2.5+/-5.6), atherothrombotic infarction (20.8% and 0.63+/-1.53), and controls (7.7% and 0.09+/-0.34). There was a correlation between the number of microbleeds and the severity of periventricular hyperintensity (r=0.626, P<0.0001). There was also a correlation between the number of microbleeds and the number of intracerebral hemorrhages (r=0.689, P<0.0001) or lacunar infarctions (r=0.514, P<0.0001). The locations of microbleeds were subcortical white matter (31.8%), thalamus (24.8%), basal ganglia (19.8%), brain stem (12.0%), and cerebellum (11.7%).
Conclusions:
The findings suggest that microbleeds on T2*-weighted MRI are an indicator of advanced small artery disease of the brain with an increased risk for bleeding. This result should be taken into consideration when treating patients with stroke, and further studies are required.
Insights
Gradient-echo T2*-weighted MRI detects silent microbleeds, which are more common in patients with intracerebral hemorrhage and lacunar infarction. These findings indicate advanced small artery disease and increased bleeding risk in stroke patients.
Area of Science:
- Neuroradiology
- Neuroimaging
- Cerebrovascular Diseases
Background:
- Gradient-echo T2*-weighted MRI is sensitive to hemosiderin deposits, indicating silent microbleeds.
- The clinical significance of these microbleeds requires further investigation.
Purpose of the Study:
- To determine the incidence and number of microbleeds across different stroke subtypes.
- To correlate microbleed presence with stroke recurrence and leukoaraiosis severity.
Main Methods:
- 213 patients were classified into atherothrombotic infarction, cardioembolic infarction, lacunar infarction, intracerebral hemorrhage, and control groups.
- Gradient-echo T2*-weighted MRI at 1.5 T was used to locate and count asymptomatic microbleeds.
Main Results:
- Microbleeds were significantly more frequent in intracerebral hemorrhage (71.4%) and lacunar infarction (62.1%) groups.
- A correlation was found between microbleed number and periventricular hyperintensity severity (r=0.626).
- Microbleed counts correlated with intracerebral hemorrhages (r=0.689) and lacunar infarctions (r=0.514).
Conclusions:
- Microbleeds on T2*-weighted MRI suggest advanced small artery disease.
- The presence of microbleeds indicates an increased risk of bleeding.
- Findings should inform stroke patient management, necessitating further research.