Quantitative susceptibility mapping improves cerebral microbleed detection relative to susceptibility‐weighted images

• Published in: Journal of neuroimaging 2023-01, Vol.33 (1), p.138-146
• Main Authors: Lee, Kyuwon, Ellison, Brian, Selim, Magdy, Long, Ngo H., Filippidis, Aristotelis, Thomas, Ajith J., Spincemaille, Pascal, Wang, Yi, Soman, Salil
• Format: Article
• Language: English
• Subjects: Basal ganglia; brain calcifications; Brain Mapping; Brain stem; Calcification; Calcinosis - diagnostic imaging; Cerebellum; Cerebral Hemorrhage - diagnostic imaging; cerebral microbleed; Computed tomography; Dipoles; Ganglia; Generalized linear models; Hemorrhage; Humans; Intracranial Hemorrhages; Lesions; Linear Models; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Mapping; Medical imaging; MRI hemorrhage; Neuroimaging; quantitative susceptibility mapping; Radiography; Radiology; Statistical analysis; Statistical models; Susceptibility; susceptibility‐weighted imaging
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.13054

Background and Purpose Cerebral microbleed (CMB) detection impacts disease diagnosis and management. Susceptibility‐weighted imaging (SWI) MRI depictions of CMBs are used with phase images (SWIP) to distinguish blood from calcification, via qualitative intensity evaluation (bright/dark). However, the intensities depicted for a single lesion can vary within and across consecutive SWIP image planes, impairing the classification of findings as a CMB. We hypothesize that quantitative susceptibility mapping (QSM) MRI, which maps tissue susceptibility, demonstrates less in‐ and through‐plane intensity variation, improving the clinician's ability to categorize a finding as a CMB. Methods Forty‐eight patients with acute intracranial hemorrhage who received multi‐echo gradient echo MRI used to generate both SWI/SWIP and morphology‐enabled dipole inversion QSM images were enrolled. Five hundred and sixty lesions were visually classified as having homogeneous or heterogeneous in‐plane and through‐plane intensity by a neuroradiologist and two diagnostic radiology residents using published rating criteria. When available, brain CT scans were analyzed for calcification or acute hemorrhage. Relative risk (RR) ratios and confidence intervals (CIs) were calculated using a generalized linear model with log link and binary error. Results QSM showed unambiguous lesion signal intensity three times more frequently than SWIP (RR = 0.3235, 95% CI 0.2386‐0.4386, p