QSM predicts haemorrhage risk in brainstem cavernous malformations: a multicentre prospective study

Area of Science:

• Neuroimaging
• Radiology
• Medical Diagnostics

Background:

• Brainstem cavernous malformations (CMs) pose a risk of symptomatic hemorrhage.
• Predictive biomarkers are needed to assess hemorrhage risk in patients with brainstem CMs.
• Quantitative susceptibility mapping (QSM) is an advanced MRI technique.

Purpose of the Study:

• To evaluate the predictive value of baseline QSM metrics for future symptomatic hemorrhages in brainstem CMs.
• To determine if QSM can serve as an imaging biomarker for hemorrhage risk stratification.

Main Methods:

• Prospective multicenter cohort study of 155 patients with brainstem CMs.
• Analysis of baseline QSM metrics (mean, median, IQR, maximum susceptibility).
• Propensity score matching and Cox regression models to assess hemorrhage risk.
• Receiver operating characteristic (ROC) analyses for risk stratification thresholds.

Main Results:

• Baseline QSM median susceptibility (QSMmedian) and IQR of susceptibility (QSMIQR) significantly predicted hemorrhage risk.
• QSMmedian (AUC=0.759) and QSMIQR (AUC=0.740) showed modest predictive performance.
• Risk stratification identified distinct 2-year hemorrhage-free survival rates (83.3% low-risk, 62.8% intermediate-risk, 35.7% high-risk).

Conclusions:

• QSM metrics, particularly QSMmedian and QSMIQR, are valuable predictors of future symptomatic hemorrhages in brainstem CMs.
• QSM shows potential as a complementary imaging biomarker for prognostic models in CM management.
• Further validation in larger, independent cohorts is recommended.