Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tools to Detect Microbleed in Sentinel Headache

Ishii, Daizo; Nakagawa, Daichi; Zanaty, Mario; Roa, Jorge A; Kasab, Sami Al; Shaban, Amir; Hudson, Joseph S.; Osorno‐Cruz, Carlos; Byer, Stefano; Allan, Lauren; Torner, James C.; Awad, Issam A.; Carroll, Timothy J.; Samaniego, Edgar A; Hasan, David

doi:10.3390/jcm9040979

Cited by 13 publications

(6 citation statements)

References 34 publications

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“…Ishii et al . 6 detected microhemorrhages in 24% (12/51) of patients with unruptured intracranial aneurysm using QSM, and all these patients had a history of severe headaches suggestive of sentinel headaches. In the present study, interobserver agreement using kappa for the detection of microhemorrhages in intracranial aneurysm walls was 0.94.…”

Section: Discussionmentioning

confidence: 97%

“…VW-MRI can also identify atherosclerotic calcifications as a dark signal intensity across all sequences, which is not easy compared to the identification of dissecting intramural hematomas. Susceptibility-weighted imaging (SWI) is a useful processing technique for identifying vessel wall hematoma and calcifications as it presents opposite signal intensity based on phase information 6 , 7 . Therefore, SWI has been clinically used to qualitatively differentiate intracranial vessel wall hematomas and calcifications.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and intra-and interobserver reproducibility of quantitative susceptibility mapping with radiomic features for intracranial dissecting intramural hematomas and atherosclerotic calcifications

Park

Kim

Jung

et al. 2023

Sci Rep

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Quantitative susceptibility mapping (QSM) for 61 patients with dissecting intramural hematomas (n = 36) or atherosclerotic calcifications (n = 25) in intracranial vertebral arteries were collected to assess intra- and interobserver reproducibility in a 3.0-T MR system between January 2015 and December 2017. Two independent observers each segmented regions of interest for lesions twice. The reproducibility was evaluated using intra-class correlation coefficients (ICC) and within-subject coefficients of variation (wCV) for means and concordance correlation coefficients (CCC) and ICC for radiomic features (CCC and ICC > 0.85) were used. Mean QSM values were 0.277 ± 0.092 ppm for dissecting intramural hematomas and − 0.208 ± 0.078 ppm for atherosclerotic calcifications. ICCs and wCVs were 0.885–0.969 and 6.5–13.7% in atherosclerotic calcifications and 0.712–0.865 and 12.4–18.7% in dissecting intramural hematomas, respectively. A total of 9 and 19 reproducible radiomic features were observed in dissecting intramural hematomas and atherosclerotic calcifications, respectively. QSM measurements in dissecting intramural hematomas and atherosclerotic calcifications were feasible and reproducible between intra- and interobserver comparisons, and some reproducible radiomic features were demonstrated.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Feasibility and intra-and interobserver reproducibility of quantitative susceptibility mapping with radiomic features for intracranial dissecting intramural hematomas and atherosclerotic calcifications

Park

Kim

Jung

et al. 2023

Sci Rep

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“…Sentinel headache was described more than 20 years ago by Gorelick PB et al [ 6 ]. Sentinel headache is considered as a signal of the impending rupture of an aneurysm [ 7 ]. Since we studied symptoms before a rupture of intracranial aneurysms and observed such headaches [ 8 ], we decided to assess the presence of sentinel headache before ischemic stroke and transient ischemic attacks (TIA) [ 4 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke

Lebedeva

Ushenin

Gurary³

et al. 2022

J Headache Pain

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Background Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache. Methods This prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache. Results Our previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%. Conclusions We suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity.

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“…The most frequent symptom is headache, which may be general (25%) or localized (18%). General headaches are assumed to be caused by a minor aneurysmal hemorrhage [ 7 , 8 ]. A warning leak prior to the SAH was observed in 36% of patients in the prospective series by Sørensen et al [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Warning Signs in the Era of Unruptured Intracranial Aneurysms: Report on 2 Cases of Fatal Aneurysmal Hemorrhage

Wójtowicz¹,

Kunert²,

Przepiórka³

et al. 2021

Cerebrovasc Dis Extra

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Introduction: The timing of treatment remains unresolved for patients with unruptured intracranial aneurysms (UIAs) and headaches, particularly when the pain is short term, localized, and related to the aneurysm site. We lack evidence to support the notion that when a headache accompanies an aneurysm, it elevates the risk of rupture. Results: We describe 2 cases of fatal subarachnoid hemorrhage in patients with a history of headache and known aneurysms. Both of these patients had good indications for treatment: a young age and an aneurysm >7 mm, and both were qualified for elective surgery. However, both patients died of fatal aneurysm ruptures before the planned surgery. Conclusion: These cases suggested that treatment should be started as soon as possible, when a UIA is diagnosed based on a short-term period of severe headaches or when a UIA is observed and then severe headaches appear. There is no straightforward guideline for treatment timing in these patients. However, in this era of UIAs, the significance of sentinel headaches should be reevaluated. Given the incidence of headaches in the general population and the very low risk of aneurysm rupture, there may be a tendency to neglect the role of headache as a possible warning sign.

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Quantitative Susceptibility Mapping and Vessel Wall Imaging as Screening Tools to Detect Microbleed in Sentinel Headache

Cited by 13 publications

References 34 publications

Feasibility and intra-and interobserver reproducibility of quantitative susceptibility mapping with radiomic features for intracranial dissecting intramural hematomas and atherosclerotic calcifications

Feasibility and intra-and interobserver reproducibility of quantitative susceptibility mapping with radiomic features for intracranial dissecting intramural hematomas and atherosclerotic calcifications

Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke

Warning Signs in the Era of Unruptured Intracranial Aneurysms: Report on 2 Cases of Fatal Aneurysmal Hemorrhage

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