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: 10056400
• 负责人: Salil Soman
• 金额: $ 26.72万
• 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 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10056400
• 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; Risk stratification; 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; 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）是小的脑出血（MRI上小于1 cm，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），并且 与更大的脑出血、认知能力下降和动脉瘤破裂的风险增加有关。他们也是 与多种疾病的不良结局相关，包括中风患者血栓形成后的脑出血 与没有服用抗血栓药物的患者相比， CMB。CMB的检测在基于其数量的患者治疗管理中起着重要作用， 不幸的是，可检测到的CMB的数量和位置非常高， 取决于所使用的MRI成像的类型。例如，虽然3 T SWI成像是最敏感的 临床可用的CMB成像方法，放射学成像与脑组织相关的研究 检查已经证明，组织中高达75%的CMB不能被3 T SWI MRI检测到。 此外，SWI已被证明很难区分CMB和钙化，这是一种常见的情况 CMB模拟。 在SWI和类似的临床使用的MRI技术中观察到的许多技术变异性并不存在于 一种新的MRI技术，称为定量磁化率映射（QSM）。然而，大多数QSM成像需要 要掩蔽的颅骨（mQSM），导致在所得图像中遗漏大脑的随机部分。我们 研究表明，一种不需要掩蔽的较新的QSM（称为pQSM）显示出许多 在mQSM图像上看不到的大脑。我们还发现，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由神经放射科医生阅读。这个项目的目标是研究 神经放射科医生如何阅读pQSM和SWI图像以评估CMB的差异，并观察这些差异是否存在。 差异将导致与所识别的CMB的数量和/或位置相关的不同的患者护理。我们 获得了一组因大量出血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， 显示他们脑内大量出血和钙化我们计划使用这些数据来制作SWI和pQSM 由神经放射学专家组成的阅片小组对CMB进行审查。因为我们不能从 对于这些患者，我们招募了额外的神经放射科医生作为专家小组，在SWI上选择区域 和pQSM图像来分类为CMB或非CMB，以作为金标准。读者神经放射学家 然后将审查专家小组为CMB标记的这些领域。