3 years ago

Quantitative susceptibility mapping as a monitoring biomarker in cerebral cavernous malformations with recent hemorrhage

Timothy Carroll, Romuald Girard, Daniel Hanley, Maged D. Fam, Nicholas Hobson, Ying Cao, Nichol McBee, Richard E. Thompson, Huan Tan, Hussein A. Zeineddine, Issam A. Awad, Robert Shenkar, Kiranj Chaudagar, Jingjing Shen, Agnieszka Stadnik, Gregory A. Christoforidis
Background Quantitative Susceptibility Mapping (QSM) MRI allows accurate assessment of iron content in cerebral cavernous malformations (CCM), and a threshold increase by 6% in QSM has been shown to reflect new symptomatic hemorrhage (SH) in previously stable lesions. Purpose/Hypothesis It is unclear how lesional QSM evolves in CCMs after recent SH, and whether this could serve as a monitoring biomarker in clinical trials aimed at preventing rebleeding in these lesions. Study Type This is a prospective observational cohort study. Population 16 CCM patients who experienced a SH within the past year, whose lesion was not resected or irradiated. Field Strength/Sequence The data acquisition was performed using QSM sequence implemented on a 3T MRI system Assessment The lesional QSM assessments at baseline and yearly during 22 patient-years of follow-up were performed by a trained research staff including imaging scientists. Statistical Tests Biomarker changes were assessed in relation to clinical events. Clinical trial modeling was performed using two-tailed tests of time-averaged difference (assuming within-patient correlation of 0.8, power = 0.9 and alpha = 0.1) to detect 20%, 30% or 50% effects of intervention on clinical and biomarkers event rates during two years of follow-up. Results The change in mean lesional QSM of index hemorrhagic lesions was +7.93% per patient-year in the whole cohort. There were 5 cases (31%) of recurrent SH or lesional growth, and twice as many instances (62%) with a threshold (6%) increase in QSM. There were no instances of SH hemorrhage or lesional growth without an associated threshold increase in QSM during the same epoch. Level of Evidence: 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2017.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/jmri.25831

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