Imaging cerebral microbleeds in Cushing’s disease evaluated by quantitative susceptibility mapping: an observational cross-sectional study

Abstract

Design Cushing’s disease (CD) is a rare clinical syndrome characterized by chronic exposure to hypercortisolism due to an adrenocorticotropic hormone-secreting pituitary adenoma. The adverse effects of chronic exposure to hypercortisolism on the human brain remain unclear. The purpose of this study was to assess the prevalence of cerebral microbleeds (CMBs) in CD patients and their associations with clinical characteristics. Methods In this study, 48 active CD patients, 39 remitted CD patients, and 52 healthy control (HC) subjects underwent MRI. CD patients also underwent neuropsychological testing and clinical examinations. The number, locations, and volumes of CMBs were assessed on quantitative susceptibility mapping (QSM) images and with the Microbleed Anatomical Rating Scale. The correlation between CMBs and clinical characteristics was explored. Results The prevalence of CMBs among active and remitted CD patients was higher than that among HCs (16.3%, 20.5%, and 3.3%, respectively). Moreover, the age of CD patients with CMBs were much younger than HCs with CMBs. Furthermore, the increased number of CMBs in active CD patients was associated with increased cerebrospinal fluid (CSF) volumes in remitted CD patients. Conclusions Chronic exposure to hypercortisolism may be relevant to CMBs and significantly correlated with altered brain volumes in CD.

Implications of quantitative susceptibility mapping at 7 Tesla MRI for microbleeds detection in cerebral small vessel disease

“…More MBs were found in the same subjects at 7T QSM when compared to 7T T2 * -w imaging, indicating a higher sensitivity of the former. The feasibility of detection of MBs using QSM has been addressed before in the ArcAβ mouse model ( 36 ), and in human patients with Cushing's disease ( 37 ), multiple sclerosis ( 38 ), and traumatic brain injury ( 39 ). However, to the best of our knowledge, this is the first work that focused on the use of QSM at high-field MRI for MBs detection in patients with CSVD and healthy elderly controls.…”

Region‐specific disturbed iron redistribution in Cushing's disease measured by magnetic resonance imaging‐based quantitative susceptibility mapping

“…All participants in the current study have been reported previously. This study demonstrated the prevalence of CMBs in patients with CD and their associations with clinical characteristics 7 …”

“…This study demonstrated the prevalence of CMBs in patients with CD and their associations with clinical characteristics. 7…”

“…Previous studies have already demonstrated hypercortisolism relative to alterations of the brain, such as atrophy of grey matter, reductions in white matter (WM) integrity and functional connectivity, and brain metabolites of patients with CD in the past three decades 3,6 . Recently, our quantitative susceptibility mapping (QSM) study found that the prevalence of cerebral microbleeds (CMBs) among patients with CD was significantly higher than that among healthy controls (HCs) 7 . Moreover, there is ongoing debate as to whether observed iron accumulation is a cause or consequence of neuronal cell death of deep grey matter nuclei (DGN) in various neurodegenerative diseases, such as Parkinson's disease (PD) and Alzheimer's disease (AD) 8 .…”

“…3,6 Recently, our quantitative susceptibility mapping (QSM) study found that the prevalence of cerebral microbleeds (CMBs) among patients with CD was significantly higher than that among healthy controls (HCs). 7 Moreover, there is ongoing debate as to whether observed iron accumulation is a cause or consequence of neuronal cell death of deep grey matter nuclei (DGN) in various neurodegenerative diseases, such as Parkinson's disease (PD) and Alzheimer's disease (AD). 8 Thus, the investigation of iron distribution in the DGN of patients with CD could help understand the mechanism of hypercortisolism in the human brain and shed light on the mechanism of neurodegenerative disease.…”