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Cerebral Microbleeds Remain for Nine Years: A Prospective Study with Yearly Magnetic Resonance Imaging
Tsukasa Saito1, Yuichiro Kawamura1, Nobuyuki Sato1
1Department of Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Asahikawa, Japan.
Background:
Cerebral microbleeds (CMBs) are refined neuroimaging findings detected on T2*-weighted gradient echo (GRE) magnetic resonance imaging (MRI) and are widely accepted as an important marker of the vulnerability of cerebral small vessels. It is necessary to further clarify the natural history of CMBs by a longitudinal study. This study aimed to reveal the natural history of CMBs and find a better way to track CMBs by a prospective long-term observation.
Methods:
We performed yearly brain MRI assessments for 7 or more years in 8 nonvalvular atrial fibrillation Japanese outpatients with CMBs detected in the baseline MRI. We began to use a 3.0T MRI scanner from 2012 as well.
Results:
We followed up 3 patients for 9 years, 2 for 8 years, and 3 for 7 years. In all patients, the CMBs at baseline did not disappear during the follow-up period. Importantly, the CMB in 1 patient seemed to disappear during the sixth imaging using 1.5T T2*-weighted GRE but was detected again during the seventh imaging with 3.0T susceptibility weighted imaging and ninth imaging with 3.0T T2* GRE. Moreover, in a patient implanted with a pacemaker, which is only applicable for 1.5T MRI at present, the CMB seemed to disappear and appeared once again with a 1.5T T2*-weighted GRE at a slice thickness of 2.5 mm instead of 5 mm.
Conclusions:
From this prospective study, we obtained 2 absolutely new findings that CMBs remained for as long as 9 years and a high-field or thin-slice MRI can detect concealed CMBs.
Insights
Cerebral microbleeds (CMBs) persist for up to 9 years, challenging previous assumptions. Advanced MRI techniques, including high-field or thin-slice imaging, can reveal previously undetected CMBs.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Cerebral microbleeds (CMBs) are key indicators of small vessel disease, visualized via T2*-weighted gradient echo (GRE) MRI.
- Longitudinal studies are crucial for understanding the natural history of CMBs.
- This study prospectively observed CMBs in patients with nonvalvular atrial fibrillation.
Purpose of the Study:
- To elucidate the long-term natural history of cerebral microbleeds.
- To identify improved methods for tracking CMBs over time.
Main Methods:
- Yearly brain MRI scans were conducted for at least 7 years on 8 Japanese outpatients with baseline CMBs.
- A 3.0T MRI scanner was utilized from 2012 onwards.
- Follow-up durations varied from 7 to 9 years.
Main Results:
- All baseline CMBs remained visible throughout the follow-up period.
- One CMB initially appeared to vanish on 1.5T T2*-GRE but reappeared on 3.0T imaging (SWI and T2*-GRE).
- A pacemaker patient's CMBs also showed transient disappearance and reappearance on 1.5T T2*-GRE with adjusted slice thickness (2.5mm vs. 5mm).
Conclusions:
- CMBs can persist for up to 9 years, indicating their long-term presence.
- High-field strength or thin-slice MRI protocols can detect CMBs that might otherwise be missed.
