Clinical Performance of Quantitative Susceptibility Mapping in Cerebral Microbleed Detection Relative to 2D GRE

Area of Science:

• Neuroimaging
• Radiology
• Medical Physics

Background:

• Cerebral microbleeds (CMBs) are small hemorrhages in the brain, often detected using MRI.
• Quantitative Susceptibility Mapping (QSM) is an emerging MRI technique for detecting CMBs.
• Comparison with established 2D gradient recalled echo (2D GRE) is crucial for clinical adoption.

Purpose of the Study:

• To compare CMB detection and burden estimation between QSM and 2D GRE.
• To assess the impact of motion artifacts and skull-stripping failures on CMB detection.
• To evaluate the relative visibility and conspicuity of CMBs detected by each technique.

Main Methods:

• Seventy-nine patients with intracranial hemorrhage underwent same-session 2D GRE and multi-echo GRE MRI for QSM.
• Neuroradiologist and research assistant reviewed images for CMB detection, visibility, and anatomical distribution.
• Statistical analyses included Wilcoxon signed-rank tests for counts and Mann-Whitney U test for motion.

Main Results:

• QSM showed comparable median CMB counts to 2D GRE (p=0.175) with strong correlation (r=0.879).
• No significant difference in motion degradation was observed between QSM and 2D GRE (p=0.7465).
• QSM demonstrated superior lesion conspicuity (p=0.00975) and correctly identified 26 calcifications misclassified as CMBs on 2D GRE.

Conclusions:

• QSM offers comparable or slightly lower CMB counts than 2D GRE.
• QSM provides superior lesion conspicuity and better differentiation of calcifications.
• These findings support the potential clinical implementation of QSM for CMB detection.