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Published on: February 19, 2021
Clinical relevance of improved microbleed detection by susceptibility-weighted magnetic resonance imaging
Jeroen D C Goos1, Wiesje M van der Flier, Dirk L Knol
1Department of Neurology and Alzheimer Center, Vrije Universiteit Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. j.goos@vumc.nl
Background And Purpose:
Susceptibility-weighted imaging (SWI) has been shown to be more sensitive in detecting cerebral microbleeds (MBs) than is conventional T2*-weighted gradient-recalled echo imaging (GRE). However, the clinical relevance of this improved detection in terms of associations with clinical measures and risk factors is unclear. We sought to determine whether associations of MBs with clinical characteristics, risk factors, white-matter hyperintensities, and lacunes were different on GRE versus SWI in memory clinic patients.
Methods:
One hundred forty-one patients presenting at our memory clinic were included and underwent clinical evaluation and a magnetic resonance imaging protocol including both GRE and SWI. Images were analyzed for numbers and locations of MBs and white-matter hyperintensities. In a subset of patients, apolipoprotein E status was determined. Negative binomial regression was used to assess clinical and radiologic associations with MB number.
Results:
MB prevalence was 23% on GRE and 40% on SWI. A total of 219 and 284 MBs were detected on GRE and SWI, respectively. Within groups with MBs, the median MB count was 1 (range, 1 to 144) on GRE and 2 (range, 1 to 129) on SWI (P<0.001). The increase in the number of MBs on SWI was equally distributed among brain regions. Strengths of the associations with age, sex, white-matter hyperintensities, and presence of lacunes with higher MB numbers were comparable for GRE and SWI (all P<0.05); no differential independent associations were detected.
Conclusions:
SWI detected more MBs in more patients, irrespective of MB location. However, this enhanced detection had no improved clinical relevance in terms of associations with vascular risk factors or radiologic markers of small-vessel disease.
Insights
Susceptibility-weighted imaging (SWI) detects more cerebral microbleeds (MBs) than gradient-recalled echo (GRE) imaging. However, this increased detection of MBs does not improve their clinical relevance regarding risk factors or markers of small-vessel disease.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Susceptibility-weighted imaging (SWI) offers higher sensitivity for detecting cerebral microbleeds (MBs) compared to conventional T2*-weighted gradient-recalled echo (GRE) imaging.
- The clinical significance of SWI's enhanced MB detection remains unclear.
Purpose of the Study:
- To compare the associations of MBs with clinical characteristics, risk factors, white-matter hyperintensities, and lacunes using GRE versus SWI in memory clinic patients.
- To determine if SWI improves the clinical relevance of MB detection.
Main Methods:
- 141 memory clinic patients underwent clinical evaluation and MRI including GRE and SWI.
- MBs and white-matter hyperintensities were quantified. Apolipoprotein E status was determined in a subset.
- Negative binomial regression analyzed associations between MB number and clinical/radiologic factors.
Main Results:
- MB prevalence was higher on SWI (40%) than GRE (23%).
- SWI detected more MBs overall, with a higher median count in patients with MBs (P<0.001).
- Associations between MB number and age, sex, white-matter hyperintensities, and lacunes were similar for both GRE and SWI.
Conclusions:
- SWI enhances the detection of cerebral microbleeds in memory clinic patients.
- Despite increased detection, SWI does not offer improved clinical relevance concerning vascular risk factors or markers of small-vessel disease.
