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Published on: September 25, 2019
The use of susceptibility-weighted imaging to detect cerebral microbleeds after lacunar infarction
1Internal Medicine-Neurology, Xuzhou First Hospital, Xuzhou, Jiangsu, China. gexuhuaxzyy@aliyun.com.
Objective:
To study the value of susceptibility-weighted imaging (SWI) technology to detect cerebral microbleeds (CMBs) in senile cerebral lacunar infarction patients; and to evaluate the complicated cerebral hemorrhage risk after patients with CMBs took aspirin, an antiplatelet medication or received anticoagulant therapy.
Patients And Methods:
MRI scanning, using GRE-T2*WI, SWI and FSE sequences (T1WI, T2WI, and T2FLAIR), was performed on the three groups: (1) a cerebral lacunar infarction group; (2) cerebral lacunar infarction with cerebral microbleeds (CMBs) group; and (3) a healthy elderly group. A total of 60 cases were in each group (180 total patients). In addition, the lacunar infarction group and lacunar infarction with CMBs groups were both treated with formal antiplatelet or anticoagulant therapy, according to medical guidelines. Patients were followed for 12 months, during which time their cerebral hemorrhages and post-event effects were observed. The relativity of CMBs, antiplatelet therapy, anticoagulant therapy and cerebral hemorrhage transformation was analyzed and defined. The two groups of research patients with lacunar infarctions were scanned with relevant sequences.
Results:
The SWI scanning sequence showed the highest positive rate of CMBs, followed by GRE-T2*WI and other conventional scanning sequences. T1WI, T2WI and T2FLAIR showed a relatively lower positive rate of CMBs. In the cerebral lacunar infarction group and healthy elderly group, 34 cases in the SWI sequence showed 84 positive sites; 18 cases in the GRE-T2*WI sequence showed 40 positive sites; 2 cases in the T1WI sequence showed 4 positive sites; and 6 cases in the T2WI sequence showed 11 positive sites. After a chi-squared test, the differences between the sequences were statistically significant (p < 0.05). In the lacunar infarction group, 26 cases (43.33%) exhibited microbleeding lesions, while the normal control group represented 8 cases (13.33%). The lacunar infarction group exhibited mild, moderate and severe cases, the three types of CMBs. The normal control group only showed mild hemorrhaging. The degree of lacunar infarction was significantly related to the severity of CMBs (p < 0.05). After patients with CMBs had received formal antiplatelet therapy and anticoagulation therapy, one case in the lacunar infarction with microbleeds group showed cerebral hemorrhaging, but this had no statistical significance (p > 0.05).
Conclusions:
The SWI scanning sequence is more sensitive than the GRE-T2*WI sequence. The GRE-T2*WI sequence is more sensitive than the conventional FSE sequence. SWI is highly sensitive and specific to the diagnosis of CMBs. It is an accurate and effective method for the analysis and diagnosis of CMBs. If patients with CMBs caused by lacunar infarction are treated with antiplatelet and anticoagulant therapy, the risk of cerebral hemorrhagic transformation is relatively smaller within 12 months. However, this needs to be observed further to define possible long-term risks.
Insights
Susceptibility-weighted imaging (SWI) is highly sensitive for detecting cerebral microbleeds (CMBs) in patients with lacunar infarction. Treatment with antiplatelet or anticoagulant therapy showed a relatively smaller risk of cerebral hemorrhagic transformation within 12 months.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cerebral microbleeds (CMBs) are common in senile cerebral lacunar infarction.
- Detecting CMBs is crucial for assessing hemorrhage risk.
- Conventional MRI sequences have limitations in detecting CMBs.
Purpose of the Study:
- To evaluate the diagnostic value of susceptibility-weighted imaging (SWI) for detecting CMBs in patients with lacunar infarction.
- To assess the risk of cerebral hemorrhage transformation in patients with CMBs receiving antiplatelet or anticoagulant therapy.
Main Methods:
- MRI scans including GRE-T2*WI, SWI, and FSE sequences were performed on 180 patients (60 per group: lacunar infarction, lacunar infarction with CMBs, healthy elderly).
- Patients with lacunar infarction received antiplatelet or anticoagulant therapy.
- Follow-up for 12 months to observe cerebral hemorrhages and post-event effects.
Main Results:
- SWI demonstrated the highest positive rate for CMB detection, significantly higher than GRE-T2*WI and conventional sequences (p < 0.05).
- Lacunar infarction patients had a significantly higher prevalence and severity of CMBs compared to the healthy elderly group (p < 0.05).
- Only one case of cerebral hemorrhage occurred in the CMBs group receiving therapy, with no statistical significance (p > 0.05).
Conclusions:
- SWI is a highly sensitive and specific tool for diagnosing CMBs in lacunar infarction.
- GRE-T2*WI is more sensitive than conventional FSE sequences for CMB detection.
- Antiplatelet and anticoagulant therapy in patients with CMBs may reduce the risk of cerebral hemorrhagic transformation within 12 months, warranting further long-term observation.
