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J Magn Reson Imaging. 2018 Apr;47(4):1133-1138. doi: 10.1002/jmri.25831. Epub 2017 Aug 9.

Quantitative susceptibility mapping as a monitoring biomarker in cerebral cavernous malformations with recent hemorrhage.

Author information

1
Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA.
2
Brain Injury Outcomes unit, Johns Hopkins University, Baltimore, Maryland, USA.
3
Department of Diagnostic Radiology, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA.

Abstract

BACKGROUND:

Quantitative Susceptibility Mapping (QSM) MRI allows accurate assessment of iron content in cerebral cavernous malformations (CCM), and a threshold increase by 6% in QSM has been shown to reflect new symptomatic hemorrhage (SH) in previously stable lesions.

PURPOSE/HYPOTHESIS:

It is unclear how lesional QSM evolves in CCMs after recent SH, and whether this could serve as a monitoring biomarker in clinical trials aimed at preventing rebleeding in these lesions.

STUDY TYPE:

This is a prospective observational cohort study.

POPULATION:

16 CCM patients who experienced a SH within the past year, whose lesion was not resected or irradiated.

FIELD STRENGTH/SEQUENCE:

The data acquisition was performed using QSM sequence implemented on a 3T MRI system ASSESSMENT: The lesional QSM assessments at baseline and yearly during 22 patient-years of follow-up were performed by a trained research staff including imaging scientists.

STATISTICAL TESTS:

Biomarker changes were assessed in relation to clinical events. Clinical trial modeling was performed using two-tailed tests of time-averaged difference (assuming within-patient correlation of 0.8, power = 0.9 and alpha = 0.1) to detect 20%, 30% or 50% effects of intervention on clinical and biomarkers event rates during two years of follow-up.

RESULTS:

The change in mean lesional QSM of index hemorrhagic lesions was +7.93% per patient-year in the whole cohort. There were 5 cases (31%) of recurrent SH or lesional growth, and twice as many instances (62%) with a threshold (6%) increase in QSM. There were no instances of SH hemorrhage or lesional growth without an associated threshold increase in QSM during the same epoch.

LEVEL OF EVIDENCE:

1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:1133-1138.

KEYWORDS:

QSM; cerebral cavernous malformation; clinical trials; imaging biomarker

PMID:
28791783
PMCID:
PMC5807224
[Available on 2019-04-01]
DOI:
10.1002/jmri.25831

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