• 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, and Issam A Awad.
• Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA.
• J Magn Reson Imaging. 2018 Apr 1; 47 (4): 1133-1138.

BackgroundQuantitative 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/HypothesisIt 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 TypeThis is a prospective observational cohort study.Population16 CCM patients who experienced a SH within the past year, whose lesion was not resected or irradiated.Field Strength/SequenceThe 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 TestsBiomarker 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.ResultsThe 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 Evidence1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:1133-1138.© 2017 International Society for Magnetic Resonance in Medicine.

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