Role of T2* GRE MRI Sequence in Detecting Cerebral Microbleeds in Hypertensive Patients Presenting with Intra Cerebral Hemorrhage
DOI:
https://doi.org/10.37762/jgmds.11-3.590Keywords:
Intracerebral hemorrhage (ICH), Cerebral microbleeds (CMBs), Hypertension, T2*gradient echo MRI, Susceptibility weighted images (SWI)Abstract
OBJECTIVES
Examine the efficacy of T2* gradient echo in detecting Cerebral microbleeds (CMBs) among hypertensive patients, emphasizing its efficiency in acquisition time. Evaluate its potential as an alternative to susceptibility-weighted imaging (SWI) in routine assessments for hypertensive individuals.
METHODOLOGY
A cross-sectional study from Sep 2021 to January 2023 was conducted at the Radiology Unit of Lady Reading Hospital Peshawar. Patients suspected of having a cerebrovascular accident (CVA) were referred from different units who had proven Intracerebral hemorrhage (ICH) on initial CT brain. The exclusion criteria were a history of recent trauma aneurysms/tumors on the present scan. The MRI examination included sequences like T1, T2, FLAIR, DWI/ADC, and T2*. The CMB was defined as a hypointense focus of signal drops out, measuring 5-10mm, with blooming artefact on T2* images and no surrounding edema.
RESULTS
62 patients were included in the study, with an equal proportion of males and females and age ranges between 46 to 78 years (62 ± 4.7). Forty-one cases had CMBs on T2* sequence in these 62 cases (66%), and 18 (44%) cases out of 41 were visible on T2WI. No significant correlation was seen between grades of CMBs and the location or size of the microbleed on Spearman’s test.
CONCLUSION
T2*GRE weighting can effectively detect CMBs compared to SWI. Therefore, this sequence could be employed in hospitals with increased workloads due to short acquisition time instead of the longer time for SWI.
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Ziai WC, Carhuapoma JR. Intracerebral Hemorrhage. Continuum (Minneap Minn). 2018;24(6):1603-22. DOI: https://doi.org/10.1212/CON.0000000000000672
Han R, Lan X, Han Z, Ren H, Aafreen S, Wang W, et al. Improving outcomes in intracerebral hemorrhage through microglia/macrophage-targeted IL-10 delivery with phosphatidylserine liposomes. Biomaterials. 2023;301:122277. DOI: https://doi.org/10.1016/j.biomaterials.2023.122277
Weerink LB, Appelman AP, Kloet RW, Van der Hoorn A. Susceptibility-weighted imaging in intracranial hemorrhage: Not all bleeds are black. Br J Radiol. 2023;96(1148). DOI: https://doi.org/10.1259/bjr.20220304
Anisetti B, Stewart MW, Eggenberger ER, Shourav MM, Youssef H, Elkhair A, et al. Age-related macular degeneration is associated with probable cerebral amyloid angiopathy: A case-control study. J Stroke Cerebrovasc Dis. 2023;32(8):107244. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107244
Lyu L, Shen J, Zeng C, Ji J, Hu W, Wei T, et al. CMBs are associated with blood pressure levels in individuals with hypertension. Clin Exp Hypertens. 2019;42(4):328–34. DOI: https://doi.org/10.1080/10641963.2019.1665673
Moulin S, Cordonnier C. Role of CMBs for intracerebral haemorrhage and dementia. Curr Neurol Neurosci Rep. 2019;19(8). DOI: https://doi.org/10.1007/s11910-019-0969-0
Haller S, Vernooij MW, Kuijer JP, Larsson E-M, Jäger HR, Barkhof F. CMBs: Imaging and clinical significance. Radiology. 2018;287(1):11–28. DOI: https://doi.org/10.1148/radiol.2018170803
Sousanidou A, Tsiptsios D, Christidi F, Karatzetzou S, Kokkotis C, Gkantzios A, et al. Exploring the impact of CMBs on stroke management. Neurol Int. 2023;15(1):188–224. DOI: https://doi.org/10.3390/neurolint15010014
Kato H, Izumiyama M, Izumiyama K, Takahashi A, Itoyama Y. Silent CMBs on T2*-weighted MRI. Stroke. 2002;33(6):1536–40. DOI: https://doi.org/10.1161/01.STR.0000018012.65108.86
Jain N, Kumar S, Singh A, Jain S, Phadke RV. Blood in the brain on susceptibility-weighted imaging. Indian J Radiol Imaging. 2022;33(01):89–97 DOI: https://doi.org/10.1055/s-0042-1758880
Irimia A, Van Horn JD, Vespa PM. Cerebral CMBs due to traumatic brain injury and their effects on the aging human brain. Neurobiol Aging. 2018;66:158–64 DOI: https://doi.org/10.1016/j.neurobiolaging.2018.02.026
Lee Y-M, Koo H-W, Kang HK, Kim JW, Han SR, Yoon SW, et al. The prevalence and characterization of CMBs in young people having intracerebral hemorrhage. J Cerebrovasc Endovasc Neurosurg. 2018;20(2):112 DOI: https://doi.org/10.7461/jcen.2018.20.2.112
Charidimou A, Jäger HR, Werring DJ. Cerebral microbleed detection and mapping: Principles, methodological aspects and rationale in vascular dementia. Exp Gerontol. 2012;47(11):843–52 DOI: https://doi.org/10.1016/j.exger.2012.06.008
Chesebro AG, Amarante E, Lao PJ, Meier IB, Mayeux R, Brickman AM. Automated detection of CMBs on T2*-weighted MRI. Sci Rep. 2021;11(1) DOI: https://doi.org/10.1038/s41598-021-83607-0
Punitha P, Rajamanickam K, A K, A E, Prabhu K AD, R M. Imaging cerebral haemorrhage using MRI: Improved sensitivity of susceptibility weighted imaging (SWI) compared to gradient echo sequences (GRE). Arch Intern Med Res. 2020;03(01) DOI: https://doi.org/10.26502/aimr.0019
Shen J, Guo F, Yang P, Xu F. Influence of hypertension classification on hypertensive intracerebral hemorrhage location. J Clin Hypertens. 2021;23(11):1992–9 DOI: https://doi.org/10.1111/jch.14367
Reddy ST, Savitz SI. Hypertension-related CMBs. Case Rep Neurol. 2020;12(3):266–9 DOI: https://doi.org/10.1159/000508760
Nikseresht G, Evia AM, Nag S, Leurgans SE, Capuano AW, Agam G, et al. Neuropathologic correlates of CMBs in community-based older adults. Neurobiol Aging. 2023;129:89–98 DOI: https://doi.org/10.1016/j.neurobiolaging.2023.05.005
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