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Purpose <p>Hemosiderin-sensitive MRI sequences are commonly utilized for microbleed identification in cerebral cavernous malformations (CCM). Efficacy of susceptibility-weighted (SWI) and gradient-echo T2*-weighted imaging (GRE-T2*) sequences in detecting CCM-associated developmental venous anomalies (DVA) remains uncertain.</p> Methods <p>We conducted a retrospective review of our institutional CCM database. Inclusion criteria comprised baseline characteristics and MRI datasets involving contrast-enhanced T1 (CE-T1), T2, and SWI or GRE-T2* sequences. The presence of CCM-related DVA was determined utilizing CE-T1 imaging. A subgroup of 200 patients, evenly distributed with or without DVA, underwent random selection for analysis, with 50 patients each having SWI and GRE-T2* imaging. The presence of DVA was evaluated by two blinded neuroradiologists based on SWI or GRE-T2* sequences. Interrater agreement, sensitivity, and specificity values for SWI and GRE-T2* sequences were analyzed.</p> Results <p>Imaging assessment demonstrated observer agreement in 76% of the SWI sequences (K = 0.51, <i>p</i> &lt;0.001) and 82% of the GRE-T2* images (K = 0.39, <i>p</i> &lt;0.001). While SWI sequences exhibited a sensitivity of 81.4% and a specificity of 60.6%, GRE-T2* sequences showed a sensitivity of 19.1% and a specificity of 97.5%. Misdiagnoses were frequent in small vessel DVAs, whereas large vessel DVAs were associated with higher diagnostic accuracy in both SWI and GRE-T2* sequences (<i>p</i> =0.002).</p> Conclusion <p>Evaluation of SWI and GRE-T2* sequences for assessing CCM-related DVA appears less effective than the routine use of CE-T1 sequences. The use of contrast agents still appears necessary for detailed diagnostics and appropriate surgery planning.</p>

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Detection of cerebral cavernous malformation associated developmental venous anomalies in gradient-echo and susceptibility-weighted magnetic resonance imaging: can we skip the contrast?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月13日

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  • Laurèl Rauschenbach,
  • Alejandro N. Santos,
  • Jan Rodemerk,
  • Hanah H. Gull,
  • Thiemo F. Dinger,
  • Adrian Engel,
  • Maximilian Schüssler,
  • Yan Li,
  • Marvin Darkwah Oppong,
  • Ramazan Jabbarli,
  • Benedikt Frank,
  • Michael Forsting,
  • Karsten H. Wrede,
  • Ulrich Sure,
  • Philipp Dammann

摘要

Purpose

Hemosiderin-sensitive MRI sequences are commonly utilized for microbleed identification in cerebral cavernous malformations (CCM). Efficacy of susceptibility-weighted (SWI) and gradient-echo T2*-weighted imaging (GRE-T2*) sequences in detecting CCM-associated developmental venous anomalies (DVA) remains uncertain.

Methods

We conducted a retrospective review of our institutional CCM database. Inclusion criteria comprised baseline characteristics and MRI datasets involving contrast-enhanced T1 (CE-T1), T2, and SWI or GRE-T2* sequences. The presence of CCM-related DVA was determined utilizing CE-T1 imaging. A subgroup of 200 patients, evenly distributed with or without DVA, underwent random selection for analysis, with 50 patients each having SWI and GRE-T2* imaging. The presence of DVA was evaluated by two blinded neuroradiologists based on SWI or GRE-T2* sequences. Interrater agreement, sensitivity, and specificity values for SWI and GRE-T2* sequences were analyzed.

Results

Imaging assessment demonstrated observer agreement in 76% of the SWI sequences (K = 0.51, p <0.001) and 82% of the GRE-T2* images (K = 0.39, p <0.001). While SWI sequences exhibited a sensitivity of 81.4% and a specificity of 60.6%, GRE-T2* sequences showed a sensitivity of 19.1% and a specificity of 97.5%. Misdiagnoses were frequent in small vessel DVAs, whereas large vessel DVAs were associated with higher diagnostic accuracy in both SWI and GRE-T2* sequences (p =0.002).

Conclusion

Evaluation of SWI and GRE-T2* sequences for assessing CCM-related DVA appears less effective than the routine use of CE-T1 sequences. The use of contrast agents still appears necessary for detailed diagnostics and appropriate surgery planning.