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Updated: May 8, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Clinical Performance of Quantitative Susceptibility Mapping in Cerebral Microbleed Detection Relative to 2D GRE
Sabina Iqbal1, Nikita Seth1, Tamkin Shahraki1
11Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 02215, Boston, MA, USA.
Purpose:
To evaluate the potential overestimation of cerebral microbleed (CMB) burden by Quantitative Susceptibility Mapping (QSM) compared to 2D gradient recalled echo (2D GRE), as well as the impact of increased motion degradation due to longer scan times, reduced CMB detection from skull-stripping failures, and the relative visibility of CMBs between techniques.
Methods:
Seventy-nine adult subjects with intracranial hemorrhage underwent same-session brain MRI including 2D GRE and multi-echo GRE for QSM processing, as part of routine clinical care. Images were reviewed by a neuroradiologist and trained research assistant for CMB detection, visibility rating, and anatomical distribution. Motion artifacts and areas of non-visualized brain due to skull-stripping were assessed. Statistical analysis included Wilcoxon signed-rank tests for CMB counts, Mann-Whitney U test for motion assessment, and Fisher's exact testing for anatomical distribution patterns.
Results:
QSM showed no significant difference in median CMB counts compared to 2D GRE (1 vs 2, p = 0.175) with strong correlation (r = 0.879, p < 1.65e-26). No significant difference in motion degradation was found between techniques (p = 0.7465). Skull-stripping failures affected only 2% of candidate CMBs, in 5 of 79 (6%) subjects. QSM-detected CMBs showed superior conspicuity (73 vs 33 better visualized lesions, p = 0.00975) with 261 rated equally visible. QSM identified 26 calcifications in 20 subjects, 25 of which were misclassified as CMBs on 2D GRE.
Conclusion:
QSM demonstrates comparable or slightly lower CMB counts than 2D GRE while offering superior lesion conspicuity and ability to distinguish calcifications, supporting its potential clinical implementation for CMB detection.
Insights
Quantitative Susceptibility Mapping (QSM) shows similar cerebral microbleed (CMB) counts to 2D GRE but with better visibility and fewer false positives from calcifications. This supports QSM
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.
