Quantitative Susceptibility Mapping as a Possible Tool to Radiographically Diagnose Sentinel Headache Associated with Intracranial Aneurysm: Case Report

Nakagawa, Daichi; Cushing, Cameron M.; Nagahama, Yasunori; Allan, Lauren; Hasan, David

doi:10.1016/j.wneu.2017.04.151

Cited by 10 publications

(9 citation statements)

References 20 publications

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“…MRI-QSM is currently used to analyze cerebral non-heme ferric iron deposition in cavernous malformation, multiple sclerosis, Alzheimer’s, and a number of other neurodegenerative diseases. 2,7, 11, 13, 19, 24,25…”

mentioning

confidence: 99%

“…We previously published a case report describing a 76-year-old man with SH who was found to have positive MRI-QSM results and underwent treatment. 19 We therefore decided to perform a pilot study and include more patients in an effort to validate this finding. The objective of this pilot study was to detect microbleeds associated with SH using MRI-QSM and to clarify the morphological characteristics of unstable aneurysms with microbleeds.…”

mentioning

confidence: 99%

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Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping: pilot study

Nakagawa¹,

Kudo

Awe³

et al. 2019

Journal of Neurosurgery

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OBJECT Sentinel headaches (SHs) associated with cerebral aneurysms (CAs) could be due to microbleeds, which are considered a sign that an aneurysm is unstable. Despite the prognostic importance of these microbleeds, they remain difficult to detect using routine imaging studies. The objective of this pilot study is to detect microbleeds associated with SH using a magnetic resonance imaging (MRI) quantitative susceptibility mapping (QSM) sequence and then evaluate the morphological characteristics of unstable aneurysms with microbleeds. METHODS Twenty CAs in 16 consecutive patients with an initial presentation of headache (HA) leading to a diagnosis of CA were analyzed. Headaches in 4 of the patients (two of whom had 2 aneurysms each) met the typical definition of SH, and the other 12 patients (two of whom also had 2 aneurysms each) all had migraine HA. All patients underwent imaging with the MRI-QSM sequence. Two independent MRI experts who were blinded to the patients' clinical history performed 3D graphical analysis to evaluate for potential microbleeds associated with these CAs. Computational flow and morphometric analyses were also performed to estimate wall shear and morphological variables. RESULTS In the 4 patients with SH, MRI-QSM results were positive for 4 aneurysms, and hence these aneurysms were considered positive for non-heme ferric iron (microbleeds). The other 16 aneurysms were negative. Among aneurysm shape indices, the undulation index was significantly higher in the QSM-positive group than in the QSM-negative group. In addition, the spatial averaged wall shear magnitude was lower in the aneurysm wall in direct contact with microbleeds. CONCLUSIONS MRI-QSM allows for objective detection of microbleeds associated with SH and therefore identification of unstable CAs. CAs with slightly greater undulation indices are associated with positive MRI-QSM results and hence with microbleeds. Studies with larger populations are needed to confirm these preliminary findings.

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confidence: 99%

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confidence: 99%

Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping: pilot study

Nakagawa¹,

Kudo

Awe³

et al. 2019

Journal of Neurosurgery

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“…QSM has already been shown to be superior to SWI concerning detection of CMBs and diffuse axonal injury in traumatic brain injury patients [106], as well as superior in revealing CMBs from underlying unstable aneurysms [122,123] and cerebral cavernous malformations [124][125][126]. Those findings underscore the potential benefit of QSM for the detection of radiotherapy-induced microvascular complications, leading to an earlier and more exact assessment of risk for delayed complications in brain tumour patients.…”

Section: Quantitative Susceptibility Mapping (Qsm)mentioning

confidence: 84%

Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques

Laar

Sinnige

et al. 2019

Radiotherapy and Oncology

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“…Our group published the first case report of micro-hemorrhage detection with 7T MRI-QSM in a patient with a 7 mm ACOM aneurysm, sentinel headache, and a negative CT/lumbar puncture. 43 A follow-up study of 16 patients with 20 intracranial aneurysms demonstrated high correlation between positive MRI-QSM microbleeds, sentinel hemorrhage, and high aneurysm undulation index (undulation index=degree of surface concavity, which can vary with irregular domes or the presence of daughter sacs). 44 45 MRI-QSM may be used to evaluate the presence of microbleeds in the aneurysm wall and surrounding tissues in patients with negative aSAH on CT/lumbar puncture or in on July 11, 2020 by guest.…”

Section: Iron Imaging In the Aneurysm Wallmentioning

confidence: 99%

Vessel wall imaging in intracranial aneurysms

Samaniego

Roa

Hasan

2019

J NeuroIntervent Surg

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High-resolution vessel wall imaging (HR-vwi) is becoming a useful tool in the characterization and identification of unstable unruptured brain aneurysms. However, it has not been validated for clinical use. The current evidence on HR-vwi techniques for characterization of brain aneurysms is described in this review. Specific imaging approaches such as aneurysm wall contrast enhancement, MRi-quantitative susceptibility mapping, and 7T MRi are described in detail.

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Quantitative Susceptibility Mapping as a Possible Tool to Radiographically Diagnose Sentinel Headache Associated with Intracranial Aneurysm: Case Report

Cited by 10 publications

References 20 publications

Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping: pilot study

Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping: pilot study

Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques

Vessel wall imaging in intracranial aneurysms

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