Quantitative susceptibility mapping (QSM) as a means to monitor cerebral hematoma treatment

Zhang, Yuyao; Wei, Hongjiang; Sun, Yawen; Cronin, Matthew J.; He, Naying; Xu, Jianrong; Zhou, Yan

doi:10.1002/jmri.25957

Cited by 10 publications

(10 citation statements)

References 40 publications

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“…Moreover, the thrombus susceptibility value showed higher accuracy than the SVS diameter for predicting cardioembolic stroke, indicating that thrombus susceptibility can be used as an imaging biomarker of cardioembolism in acute ischemic stroke. Similar findings have been reported in intracranial hemorrhage studies, in which susceptibility values showed improved accuracy in assessing both hematoma and microbleed burden (17,29). Cardioembolic stroke is easily misdiagnosed in clinical practice.…”

Section: Discussionsupporting

confidence: 82%

Predictive value of thrombus susceptibility for cardioembolic stroke by quantitative susceptibility mapping

Chen¹,

Zhang²,

Nie³

et al. 2022

Quant Imaging Med Surg

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Background: The hypointense blooming signal of thrombi on susceptibility-weighted imaging (SWI), known as the susceptibility vessel sign (SVS), is predictive of cardioembolic stroke. The SVS originates from the local magnetic susceptibility effect; thus, the susceptibility value of thrombi may provide useful information in discriminating stroke etiology. We aim to utilize quantitative susceptibility mapping (QSM) to assess thrombus's susceptibility value in acute ischemic stroke patients and explore the relationship of thrombus susceptibility with cardioembolic stroke.Methods: From 2018 to 2020, 132 consecutive acute ischemic stroke patients with middle cerebral artery occlusion were recruited within 48 hours of onset. All patients underwent a three-dimensional multi-echo SWI scan using a 3 Tesla magnetic resonance imaging scanner. The SVS presence and the diameter of the SVS-related hypointense signal were assessed on SWI. QSM was applied to compute the susceptibility value of the thrombus. The receiver operating characteristic (ROC) methodology was used to define the optimal cutoff value of the susceptibility in QSM and the diameter on SWI for predicting cardioembolic stroke. Results:The SVS was identified in 93 (70.5%) patients with symptomatic middle cerebral artery occlusion and was significantly associated with cardioembolism. The hyperintense signal on QSM in the corresponding middle cerebral artery occlusion was present in 116 (87.9%) patients. ROC analysis indicated that thrombus susceptibility had a greater area under the curve than that of the SVS diameter (0.88 vs. 0.70, P<0.001) and that the optimal cutoff value of thrombus susceptibility for cardioembolism was 0.35 ppm.Multivariate analysis demonstrated that thrombus susceptibility (≥0.35 ppm) was an independent predictor of cardioembolic stroke (odds ratio =20.75; 95% CI, 7.19-59.87; P<0.001), with sensitivity, specificity, a positive predictive value, and a negative predictive value of 85.2%, 80.8%, 75.4%, and 88.7%, respectively, while the SVS presence showed sensitivity, specificity, a positive predictive value, and a negative predictive value of 90.7%, 43.6%, 87.2%, and 52.7%, respectively. Conclusion:Thrombus susceptibility provides superior diagnostic performance over the SVS for discriminating between cardioembolism and other stroke subtypes. Quantitative susceptibility measurements of thrombi may help predict cardioembolic stroke in patients with acute middle cerebral artery occlusion.

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Section: Discussionsupporting

confidence: 82%

Predictive value of thrombus susceptibility for cardioembolic stroke by quantitative susceptibility mapping

Chen¹,

Zhang²,

Nie³

et al. 2022

Quant Imaging Med Surg

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“…A previous study showed a strong correlation between magnetic susceptibility and the concentration of gadolinium (10). Susceptibility also correlated well with the concentration of iron in phantoms (11), deep gray matter (7,12,13), and hemorrhage (14,15). However, few studies have examined the relationship between CT attenuation values and susceptibility in intracranial areas that contain paramagnetic materials such as iron and diamagnetic materials such as calcification.…”

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confidence: 93%

Brain MRI with Quantitative Susceptibility Mapping: Relationship to CT Attenuation Values

Oshima¹,

Fushimi²,

Okada³

et al. 2020

Radiology

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Background: Quantitative susceptibility mapping (QSM) is used to differentiate between calcification and iron deposits. Few studies have examined the relationship between CT attenuation values and magnetic susceptibility in such materials. Purpose:To assess the relationship among metal concentration, CT attenuation values, and magnetic susceptibility in paramagnetic and diamagnetic phantoms, and the relationship between CT attenuation values and susceptibility in brain structures that have paramagnetic or diamagnetic properties. Materials and Methods:In this retrospective study, CT and MRI with QSM were performed in gadolinium and calcium phantoms, patients, and healthy volunteers between June 2016 and September 2017. In the phantom study, we evaluated correlations among metal concentration, CT attenuation values, and susceptibility. In the human study, Pearson and Spearman correlations were performed to assess the relationship between CT attenuation values and susceptibility in regions of interest placed in the globus pallidus (GP), putamen, caudate nucleus, substantia nigra, red nucleus, dentate nucleus, choroid plexus, and hemorrhagic and calcified lesions.Results: Eighty-four patients (mean age, 64.8 years 6 19.6; 49 women) and 20 healthy volunteers (mean age, 72.0 years 6 7.6; 11 men) were evaluated. In the phantoms, strong linear correlations were identified between gadolinium concentration and CT and MRI QSM values (R 2 = 0.95 and 0.99, respectively; P , .001 for both) and between calcium concentration and CT and MRI QSM values (R 2 = 0.89 [P = .005] and R 2 = 0.98 [P , .001], respectively). In human studies, positive correlations between CT attenuation values and susceptibility were observed in the GP (R 2 = 0.52, P , .001) and in hemorrhagic lesions (R 2 = 0.38, P , .001), and negative correlations were found in the choroid plexus (R 2 = 0.53, P , .001) and in calcified lesions (R 2 = 0.38, P = .009). Conclusion:CT attenuation values showed a positive correlation with susceptibility in the globus pallidus and hemorrhagic lesions and negative correlation in the choroid plexus and calcified lesions.

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“…The quantification of iron overload provides useful information in defining the therapeutic time window and the optimal duration of these treatments. Although quantitative susceptibility mapping (QSM) is more accurate for iron quantification (18), SWI is a widely available sequence and can be used in the routine clinical evaluation of iron overload after ICH.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Association of Brain Iron Overload With Brain Edema and Brain Atrophy After Intracerebral Hemorrhage

et al. 2020

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Objective: This study evaluated iron overload after intracerebral hemorrhage (ICH) using ESWAN sequences.Methods: This single-center prospective observational cohort study enrolled supratentorial ICH patients. MRI was obtained with a 3.0-T scanner at day 1, day 14, day 30, and follow-up (300 days or later). R2* mapping was generated based on the ESWAN. R2* value of the ipsilateral side represented iron deposition, and the R2* value of the contralateral side served as control. R2* value was adjusted by volume and used to assess total iron overload. Brain edema was measured on T2 FLAIR-weighted images. Brain atrophy was calculated as the contralateral hemisphere volume minus the injured hemisphere volume.Results: Twnety-seven patients with a spontaneous supratentorial ICH were included in this analysis. The ipsilateral R2* value was 40.27 ± 11.62, 41.92 ± 13.56, and 60.89 ± 14.09 at days 1, 14, and 30, respectively. The R2* value was significantly higher in the ICH side than the contralateral side (p < 0.01). Increased R2* value was seen on day 30 compared to day 14 (p < 0.01). The R2* value showed logistic decay with the distance to the hematoma margin (p < 0.01). Brain edema at day 14 and brain atrophy at follow-up correlated with R2* value adjusted by volume at day 14 (p < 0.01).Conclusions: After ICH, the iron deposition in the perihematomal region was progressively increased during the first month. R2* value adjusted by volume predicted acute brain edema and chronic brain atrophy.

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Quantitative susceptibility mapping (QSM) as a means to monitor cerebral hematoma treatment

Abstract: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:907-915.

Cited by 10 publications

References 40 publications

Predictive value of thrombus susceptibility for cardioembolic stroke by quantitative susceptibility mapping

Predictive value of thrombus susceptibility for cardioembolic stroke by quantitative susceptibility mapping

Brain MRI with Quantitative Susceptibility Mapping: Relationship to CT Attenuation Values

Association of Brain Iron Overload With Brain Edema and Brain Atrophy After Intracerebral Hemorrhage

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