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Updated: Mar 10, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Radiologic-Histopathologic Correlation of Cerebral Microbleeds Using Pre-Mortem and Post-Mortem MRI
Sven Haller1,2,3,4, Marie-Louise Montandon2,5, François Lazeyras6
1Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Carouge, Switzerland.
Introduction:
Cerebral microbleeds (CMB), also known as cerebral microhemorrhages, are small areas of susceptibility on brain magnetic resonance imaging (MRI), that are increasingly detected due to the higher availability of high-field MRI systems and dedicated pulse sequences. The prevalence of CMBs increases in cases with cognitive decline. The current investigation assessed the poorly investigated radiologic-histopathologic correlation of CMBs on MRI.
Methods:
The local ethical committee approved the current investigation. We retrospectively assessed a consecutive series of 1303 autopsy cases hospitalized in Geneva University Hospitals between 2000-2014. Of 112 cases with pre-mortem T2* sequences, we included 25 cases (mean age 77.3 ± 9.6, 9 females) with at least one CMB. We compared pre-mortem CMBs with targeted histopathology and post-mortem MRI.
Results:
25 cases had 31 CMB lesions detected by pre-mortem MRI. 25 additional CMB were detected on histopathology. 4 CMBs on pre-mortem MRI were false positives, resulting in a total of 52 CMBs. 27 CMBs on pre-mortem MRI were confirmed on histopathology, corresponding to a sensitivity or true positive rate of 51.9% (95% CI 37.6-66.0%). The false negative rate of pre-mortem MRI was 48.1% (95% CI 34.0-62.4%). Post-mortem MRI showed only 3 cases with additional CMBs. Overall, pre-mortem MRI significantly underestimated CMBs (p = 0.0001).
Conclusions:
Routine clinical brain MRI underestimates the prevalence of CMBs by approximately 50%, and 12% of radiologic pre-mortem MRI CMBs were false positives. Post-mortem MRI confirmed that this discordance is not explained by microbleeds occurring after the pre-mortem MRI.
Insights
Routine brain MRI misses about half of cerebral microbleeds (CMBs) and incorrectly identifies some as positive. This study investigated the accuracy of MRI for detecting CMBs compared to histopathology.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Cerebral microbleeds (CMBs) are increasingly detected using advanced MRI, with higher prevalence noted in cognitive decline.
- Radiologic-histopathologic correlation of CMBs remains under-investigated.
Purpose of the Study:
- To assess the accuracy of pre-mortem MRI in detecting cerebral microbleeds (CMBs).
- To compare MRI-detected CMBs with histopathology and post-mortem MRI findings.
Main Methods:
- Retrospective analysis of 25 autopsy cases with pre-mortem MRI showing at least one CMB.
- Comparison of pre-mortem MRI findings with targeted histopathology and post-mortem MRI.
Main Results:
- Pre-mortem MRI detected 31 CMBs, with histopathology identifying an additional 25.
- MRI had a sensitivity of 51.9% for CMB detection, with a false positive rate of 12%.
- Pre-mortem MRI significantly underestimated CMB prevalence (p = 0.0001).
Conclusions:
- Routine clinical brain MRI underestimates CMB prevalence by approximately 50%.
- A significant proportion of pre-mortem MRI CMBs are false positives.
- Post-mortem MRI ruled out post-imaging microbleed occurrence as the cause of discordance.
