Improved MRI Detection of Cerebral Microbleeds with Novel Susceptibility Mapping

通过新的磁敏感图改进脑微出血的 MRI 检测

• 批准号: 10191060
• 负责人: Salil Soman
• 金额: $ 22.34万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10191060
• 关键词: 3-Dimensional; Acute; Alteplase; Alzheimer' s Disease; Animals; Appearance; Area; Basal Ganglia; Blood; Brain; Brain Stem; Calcium; Caring; Cavernous Hemangioma; Cerebral Amyloid Angiopathy; Cerebral Calcification; Chronic; Classification; Clinical; Coagulation Process; Coma; Complication; Data; Dementia; Deposition; Detection; Diagnosis; Disease; Encephalopathies; Etiology; Evaluation; Excision; Goals; Gold; Head; Headache; Hemorrhage; Hospitals; Hypertensive Intracranial Hemorrhage; Image; Imaging Techniques; Impaired cognition; Intracranial Hemorrhages; Kidney Diseases; Lead; Lesion; Lobar; Location; Magnetic Resonance Imaging; Maps; Masks; Mechanics; Mental disorders; Methods; Neoplasm Metastasis; Neurologic Symptoms; Outcome; Pathology; Patient Care; Patient imaging; Patients; Pharmaceutical Preparations; Pharmacotherapy; Phase; Play; Predisposition; Publishing; Radiology Specialty; Reader; Research Personnel; Resources; Risk; Role; Ruptured Aneurysm; Scanning; Sensitivity and Specificity; Sentinel; Signal Transduction; Slice; Stroke; Syndrome; TBI Patients; Techniques; Testing; Therapeutic; Thick; Thrombectomy; Time; Tissues; Traumatic Brain Injury; Variant; Work; X-Ray Computed Tomography; base; brain parenchyma; brain tissue; calcification; cerebral microbleeds; clinical Diagnosis; clinical care; clinically significant; cranium; disability; imaging modality; improved; interest; mild traumatic brain injury; novel; patient stratification; preconditioning; radiological imaging; recruit; response; risk stratification; stroke patient; success

Cerebral microbleeds (CMBs) are small brain bleeds (less than 1 cm on MRI, and not visible on CT). Their presence is used to make multiple diagnoses (cerebral amyloid angiopathy, traumatic brain injury, acute and chronic hypertensive intracranial hemorrhage, the Alzheimer's drug complication ARIA-H, etc.), and is associated with increased risk of larger brain bleeds, cognitive decline, and aneurysm rupture. They are also associated with worse outcomes for multiple diseases, including brain bleeds in stroke patients after clot busting drugs are given and worse disability after brain clot removal in stroke, relative to patients without CMBs. Detection of CMBs plays a major role in patient therapeutic management based on their number and where in the brain they are found. Unfortunately, the number and location of detectable CMBs are highly variable depending on the type of MRI imaging used. For example, while 3T SWI imaging is the most sensitive of clinically available CMB imaging methods, studies correlating radiology imaging with brain tissue examination have demonstrated that up to 75% of CMBs in tissue are not detected by 3T SWI MRI. Additionally, SWI has been shown to have difficulty distinguishing CMBs from calcification, which is a common CMB mimic. Much of the technical variability seen in SWI and similar clinically used MRI techniques is not present in a newer MRI technique called quantitative susceptibility mapping (QSM). However, most QSM imaging requires the skull to be masked (mQSM), resulting in omission of random parts of the brain in the resultant images. Our work has shown that a newer kind of QSM, that does not require the masking (called pQSM), shows much of the brain not seen on mQSM images. We also showed that CMBs were present in some of the areas of brain that are visible on pQSM but not mQSM images. Typically, the MRIs that diagnose CMBs are read by neuroradiologists. The goal of this project is to study differences in how neuroradiologists read pQSM and SWI images for evaluating CMBs, and to see if those differences would lead to different patient care, related to the number and / or location of CMBs identified. We have access to data from a group of patients admitted to the hospital with larger bleeds, who received MRIs as part of their care that included the raw data needed to make SWI and pQSM images as well as CT scans that show their large brain bleed and areas of calcification. We plan to use this data to make SWI and pQSM images for a panel of reader neuroradiologists to review for CMBs. Because we cannot get brain tissue from these patients, we recruited additional neuroradiologists to serve as an expert panel to select areas on the SWI and pQSM images to classify as CMB or not CMB, to serve as a gold standard. The reader neuroradiologists will then review these areas marked by the expert panel for CMBs.

脑微出血 (CMB) 是小脑出血（MRI 上小于 1 厘米，CT 上不可见）。他们的 存在用于进行多种诊断（脑淀粉样血管病、创伤性脑损伤、急性和 慢性高血压颅内出血、阿尔茨海默病药物并发症 ARIA-H 等）， 与较大脑出血、认知能力下降和动脉瘤破裂的风险增加有关。他们也是 与多种疾病的较差结果相关，包括中风患者血栓后脑出血 相对于没有服用破坏性药物的患者，中风患者在脑血栓清除后残疾更严重 CMB。根据 CMB 的数量和情况，CMB 的检测在患者治疗管理中发挥着重要作用。 它们位于大脑的哪个位置。不幸的是，可探测到的宇宙微波背景的数量和位置都非常有限。 取决于所使用的 MRI 成像类型。例如，虽然 3T SWI 成像是最敏感的 临床可用的 CMB 成像方法、放射成像与脑组织相关的研究 检查表明，3T SWI MRI 无法检测到组织中高达 75% 的 CMB。 此外，SWI 已被证明难以区分 CMB 和钙化，而钙化是一种常见的疾病。 CMB 模仿。 SWI 和类似临床使用的 MRI 技术中看到的许多技术变异性在 较新的 MRI 技术称为定量磁化率绘图 (QSM)。然而，大多数 QSM 成像需要 头骨被遮盖（mQSM），导致结果图像中大脑的随机部分被遗漏。我们的 研究表明，一种不需要掩蔽的新型 QSM（称为 pQSM）显示了很多 mQSM 图像上没有看到大脑。我们还表明 CMB 存在于大脑的某些区域 在 pQSM 图像上可见，但在 mQSM 图像上不可见。 通常，诊断 CMB 的 MRI 是由神经放射科医生读取的。该项目的目标是研究 神经放射科医生在评估 CMB 时读取 pQSM 和 SWI 图像的差异，并看看这些是否 差异将导致不同的患者护理，这与所识别的 CMB 的数量和/或位置有关。我们 可以获得一组因出血量较大而入院的患者的数据，这些患者接受了 MRI 检查 他们护理的一部分包括制作 SWI 和 pQSM 图像以及 CT 扫描所需的原始数据 显示他们的大量脑出血和钙化区域。我们计划使用这些数据来制作 SWI 和 pQSM 供读者神经放射学家小组审查 CMB 的图像。因为我们无法从中获取脑组织 对于这些患者，我们招募了更多的神经放射科医生作为专家小组来选择 SWI 上的领域 和 pQSM 图像分类为 CMB 或非 CMB，作为黄金标准。神经放射学家读者 然后将审查 CMB 专家小组标记的这些领域。