The Microbleed Anatomical Rating Scale (MARS)

Grégoire, Stéphanie; Chaudhary, Ujwal; Brown, Martin M.; Yousry, Tarek; Kallis, Constantinos; Jäger, Hans Rolf; Werring, David J.

doi:10.1212/wnl.0b013e3181c34a7d

Cited by 701 publications

(538 citation statements)

References 35 publications

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“…Previous studies of CMBs on GRE report ICCs of 0.91 to 0.97 for total CMB counts, 14,15,17 and κ values generally between 0.40 to 0.75 for CMB presence or absence. 14,15,[17][18][19][20][21] By contrast, the ICC on GRE in our study was lower than for these other studies, probably reflecting differences in the populations studied. Our 9 CAA patients had a very large number of CMBs ( Table 1) that exceeded the numbers of CMBs per patient reported in other studies; therefore, interpretation of the images was time-consuming and difficult, which might have affected the reliability.…”

Section: Discussionmentioning

confidence: 80%

“…CMB interpretation was guided by a recent review 2 and 2 previously published rating scales, 14,15 which were read and discussed by all raters before beginning the study. CMB number and location were recorded as in the brain observer microbleed scale, with the exception that CMBs were recorded as present versus absent, without including an uncertain category.…”

Section: Mri Interpretationmentioning

confidence: 99%

See 1 more Smart Citation

Susceptibility-Weighted Imaging is More Reliable Than T2*-Weighted Gradient-Recalled Echo MRI for Detecting Microbleeds

Cheng

Batool

McCreary

et al. 2013

Stroke

235

140

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Background and Purpose-We investigated the sensitivity and reliability of MRI susceptibility-weighted imaging (SWI) compared with routine MRI T2*-weighted gradient-recalled echo (GRE) for cerebral microbleed (CMB) detection. Methods-We used data from a prospective study of cerebral amyloid angiopathy (n=9; mean age, 71±8.3) and healthy non-cerebral amyloid angiopathy controls (n=22; mean age, 68±6.3). Three raters (labeled 1, 2, and 3) independently interpreted the GRE and SWI sequences (using the phase-filtered magnitude image) blinded to clinical information. Results-In 9 cerebral amyloid angiopathy cases, the raters identified 1146 total CMBs on GRE and 1432 CMBs on SWI.In 22 healthy control subjects, the raters identified ≥1 CMBs in 6/22 on GRE (total 9 CMBs) and 5/22 on SWI (total 19 CMBs). Among cerebral amyloid angiopathy cases, the reliability between raters for CMB counts was good for SWI (intraclass correlation coefficient, 0.87) but only moderate for GRE (intraclass correlation coefficient, 0.52). In controls, agreement on the presence or absence of CMBs in controls was moderate to good on both SWI (κ coefficient ranged from 0.57 to 0.74 across the 3 combinations of rater pairs) and GRE (κ range, 0.31 to 0.70). A review of 114 hypointensities identified as possible CMBs indicated that increased detection and reliability on SWI was related to both increased contrast and higher resolution, allowing better discrimination of CMBs from the background and better anatomic differentiation from pial vessels. Conclusions-SWI confers greater reliability as well as greater sensitivity for CMB detection compared with GRE, and should be the preferred sequence for quantifying CMB counts. (Stroke. 2013;44:2782-2786.)

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Section: Discussionmentioning

confidence: 80%

Section: Mri Interpretationmentioning

confidence: 99%

Susceptibility-Weighted Imaging is More Reliable Than T2*-Weighted Gradient-Recalled Echo MRI for Detecting Microbleeds

Cheng

Batool

McCreary

et al. 2013

Stroke

235

140

View full text Add to dashboard Cite

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“…T2‐weighted images were analyzed simultaneously with SWI to rule out vessels and flow voids, which might mimic CMBs. CMBs were counted throughout the brain and their topographical distribution was classified as “deep,” “infratentorial,” or “lobar” according to the microbleed anatomical rating scale (MARS) (Gregoire et al., 2009). For this study, CMBs were categorized as follows: 1) SL‐CMBs, whereby CMBs were restricted to “lobar” locations, 2) M‐CMBs, whereby CMBs were in both “lobar” and “deep” and/or “infratentorial” locations.…”

Section: Methodsmentioning

confidence: 99%

Background and distribution of lobar microbleeds in cognitive dysfunction

et al. 2017

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ObjectivesCerebral microbleeds (CMBs) are often observed in memory clinic patients. It has been generally accepted that deep CMBs (D‐CMBs) result from hypertensive vasculopathy (HV), whereas strictly lobar CMBs (SL‐CMBs) result from cerebral amyloid angiopathy (CAA) which frequently coexists with Alzheimer's disease (AD). Mixed CMBs (M‐CMBs) have been partially attributed to HV and also partially attributed to CAA. The aim of this study was to elucidate the differences between SL‐CMBs and M‐CMBs in terms of clinical features and regional distribution.MaterialsWe examined 176 sequential patients in our memory clinic for clinical features and CMB location using susceptibility‐weighted images obtained on a 3T‐MRI. The number of lobar CMBs in SL‐CMBs and M‐CMBs was counted in each cerebral lobe and their regional density was adjusted according to the volume of each lobe.ResultsOf the total 176 patients, 111 patients (63.1%) had CMBs. Within the patients who had CMBs, M‐CMBs were found in 54 patients (48.6%), followed by SL‐CMBs in 35 (31.5%) and D‐CMBs in 19 (17.1%). The SL‐CMB group showed a significantly higher prevalence of family history of dementia, whereas the M‐CMB group showed an increasing trend toward hypertension and smoking. The prevalence of AD was significantly higher in the SL‐CMBs group, whereas the prevalence of AD with cerebrovascular disease was higher in the M‐CMBs group. The regional density of lobar CMBs was significantly higher in the occipital lobe in the M‐CMB group, whereas the SL‐CMB group showed higher regional density between regions an increasing tendency in the parietal and occipital lobe.ConclusionThe between‐group differences in clinical features and regional distribution indicate there to be an etiological relationship of SL‐CMBs to AD and CAA, and M‐CMBs to both HV and CAA.

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“…Microbleeds were defined as rounded, hypodense foci up to 10 mm in size and were differentiated from microbleed mimics 10. The locations and numbers of microbleeds were scored according to the Microbleed Anatomical Rating Scale,11 and microbleed burden was graded as 0, 1, 2 to 4, and ≥5, as per recent systematic reviews 4. The severity of white matter hyperintensity (WMH) was determined according to the Fazekas scale 12.…”

Section: Methodsmentioning

confidence: 99%

Long‐Term Prognostic Implications of Cerebral Microbleeds in Chinese Patients With Ischemic Stroke

Lau

Wong

Teo

et al. 2017

JAHA

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BackgroundThis study was performed to determine the clinical correlates and long‐term prognostic implications of microbleed burden and location in Chinese patients with ischemic stroke.Methods and ResultsWe recruited 1003 predominantly Chinese patients with ischemic stroke who received magnetic resonance imaging at the University of Hong Kong. We determined the clinical correlates of microbleeds and the long‐term risks (3126 patient‐years of follow‐up) of recurrent ischemic stroke and intracerebral hemorrhage (ICH) by microbleed burden (0 versus 1, 2–4, and ≥5) and location, adjusting for age, sex, and vascular risk factors and stratified by antithrombotic use. Microbleeds were present in 450 of 1003 of the study population (119/450 had ≥5, 187/450 had mixed location). Having ≥5 microbleeds was independently associated with prior antiplatelet and anticoagulant use, whereas microbleeds of mixed location were independently associated with hypertension and prior anticoagulant use (all P<0.05). Microbleed burden was associated with an increased risk of ICH (microbleed burden versus no microbleeds: 1 microbleed: multivariate hazard ratio: 0.59 [95% confidence interval, 0.07–5.05]; 2–4 microbleeds: multivariate hazard ratio: 2.14 [95% confidence interval, 0.50–9.12]; ≥5 microbleeds: multivariate hazard ratio: 9.51 [95% confidence interval, 3.25–27.81]; P trend<0.0001), but the relationship of microbleed burden and risk of recurrent ischemic stroke was not significant (P trend=0.054). Similar findings were noted in the 862 of 1003 patients treated with antiplatelet agents only (ICH: P trend<0.0001; ischemic stroke P trend=0.096). Multivariate analysis revealed that, independent of vascular risk factors, antithrombotic use, and other neuroimaging markers of small vessel disease, having ≥5 microbleeds (multivariate hazard ratio: 6.08 [95% confidence interval, 1.11–33.21]; P=0.037) was identified as an independent predictor of subsequent ICH, but neither microbleed burden nor location was predictive of recurrent ischemic stroke risk.ConclusionsIn Chinese patients with ischemic stroke, a high burden of cerebral microbleeds was significantly associated with an increased risk of ICH; however, neither microbleed location nor burden was associated with recurrent ischemic stroke risk.

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The Microbleed Anatomical Rating Scale (MARS)

Abstract: The Microbleed Anatomical Rating Scale has good intrarater and interrater reliability for the presence of definite microbleeds in all brain locations when applied to different MRI sequences and levels of observer experience.

Cited by 701 publications

References 35 publications

Susceptibility-Weighted Imaging is More Reliable Than T2*-Weighted Gradient-Recalled Echo MRI for Detecting Microbleeds

Susceptibility-Weighted Imaging is More Reliable Than T2*-Weighted Gradient-Recalled Echo MRI for Detecting Microbleeds

Background and distribution of lobar microbleeds in cognitive dysfunction

Long‐Term Prognostic Implications of Cerebral Microbleeds in Chinese Patients With Ischemic Stroke

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