Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tools to Detect Microbleed in Sentinel Headache
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Updated: Dec 25, 2025
A Volumetric Method for Quantification of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage
Published on: July 28, 2018
Daizo Ishii1, Daichi Nakagawa2, Mario Zanaty1
1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Background:
MR-quantitative susceptibility mapping (QSM) can identify microbleeds (MBs) in intracranial aneurysm (IA) wall associated with sentinel headache (SH) preceding subarachnoid hemorrhage. However, its use is limited, due to associated skull base bonny and air artifact. MR-vessel wall imaging (VWI) is not limited by such artifact and therefore could be an alternative to QSM. The purpose of this study was to investigate the correlation between QSM and VWI in detecting MBs and to help develop a diagnostic strategy for SH.
Methods:
We performed a prospective study of subjects with one or more unruptured IAs in our hospital. All subjects underwent evaluation using 3T-MRI for MR angiography (MRA), QSM, and pre- and post-contrast VWI of the IAs. Presence/absence of MBs detected by QSM was correlated with aneurysm wall enhancement (AWE) on VWI.
Results:
A total of 40 subjects harboring 51 unruptured IAs were enrolled in the study. MBs evident on the QSM sequence was detected in 12 (23.5%) IAs of 11 subjects. All these subjects had a history of severe headache suggestive of SH. AWE was detected in 22 (43.1%) IAs. Using positive QSM as a surrogate for MBs, the sensitivity, specificity, positive predictive value, and negative predictive value of AWE on VWI for detecting MBs were 91.7%, 71.8%, 50%, and 96.6%, respectively.
Conclusions:
Positive QSM findings strongly suggested the presence of MBs with SH, whereas, the lack of AWE on VWI can rule it out with a probability of 96.6%. If proven in a larger cohort, combining QSM and VWI could be an adjunctive tool to help diagnose SH, especially in cases with negative or non-diagnostic CT and lumbar puncture.
Insights
Quantitative susceptibility mapping (QSM) detects microbleeds in intracranial aneurysms associated with sentinel headache. Vessel wall imaging (VWI) shows promise in ruling out microbleeds when QSM is positive, aiding diagnosis.
Area of Science:
- Neuroimaging
- Radiology
- Cerebrovascular Diseases
Background:
- Quantitative susceptibility mapping (QSM) can identify microbleeds (MBs) in intracranial aneurysm (IA) walls linked to sentinel headache (SH).
- Skull base bone and air artifacts limit QSM's utility for intracranial aneurysms.
- MR-vessel wall imaging (VWI) offers an artifact-free alternative for detecting intracranial aneurysm wall abnormalities.
Purpose of the Study:
- To investigate the correlation between QSM and VWI in detecting MBs within intracranial aneurysm walls.
- To explore the potential of combining QSM and VWI for diagnosing sentinel headache (SH).
Main Methods:
- Prospective study involving 40 subjects with unruptured intracranial aneurysms.
- 3T-MRI evaluation included MR angiography (MRA), QSM, and pre- and post-contrast VWI.
- Correlation analysis between QSM-detected MBs and aneurysm wall enhancement (AWE) on VWI.
Main Results:
- Microbleeds (MBs) were detected by QSM in 12 (23.5%) of 51 intracranial aneurysms (IAs); all subjects reported sentinel headache (SH).
- Aneurysm wall enhancement (AWE) on VWI was observed in 22 (43.1%) IAs.
- VWI demonstrated 91.7% sensitivity and 96.6% negative predictive value for detecting MBs when QSM was positive.
Conclusions:
- Positive QSM findings strongly suggest MBs associated with SH.
- Absence of AWE on VWI can effectively rule out MBs (96.6% probability).
- Combining QSM and VWI may serve as an adjunctive diagnostic tool for SH, particularly when CT and lumbar puncture are non-diagnostic.
