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

Hussein A. Zeineddine, Romuald Girard, Ying Cao, Nicholas Hobson, Maged D. Fam, Agnieszka Stadnik, Huan Tan, Jingjing Shen, Kiranj Chaudagar, Robert Shenkar, Richard E. Thompson, Nichol McBee, Daniel Hanley, Timothy Carroll, Gregory A. Christoforidis, Issam A. Awad

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


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 2018;47:1133–1138.

Original languageEnglish (US)
Pages (from-to)1133-1138
Number of pages6
JournalJournal of Magnetic Resonance Imaging
Issue number4
StatePublished - Apr 2018


  • QSM
  • cerebral cavernous malformation
  • clinical trials
  • imaging biomarker

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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