Skip to main content Accessibility help
×
Home
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Print publication year: 2011
  • Online publication date: July 2011

Chapter 8 - Relationship of cerebral microbleeds to other imaging findings

from Section 2 - Mechanisms underlying microbleeds

Summary

Of the metals that are commonly present in the human brain, it is considered that only iron in the form of ferritin and hemosiderin is present in sufficient quantities and appropriate oxidation state to be visualized by magnetic resonance imaging (MRI). Histology has shown that cerebral microbleeds (CMBs) contain hemosiderin deposits, a paramagnetic substance. In attempts to quantify the actual susceptibility distribution, many different models have been proposed, which relate measurable MRI effects to the underlying susceptibility distribution. However, for the detection of CMBs it is probably sufficient to use qualitative techniques with a high sensitivity to magnetic field inhomogeneities to provide information on the location and approximate size of the CMB. This chapter describes some possible technical developments to discriminate between some of the different origins of signal loss. The introduction of higher-field scanners and the development of new sequences can provide increased sensitivity for the detection of CMBs.

References

1. RoobG, SchmidtR, KapellerPet al. MRI evidence of past cerebral microbleeds in a healthy elderly population. Neurology 1999;52:991–4.
2. VernooijMW, van der LugtA, IkramMAet al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology 2008;70:1208–14.
3. CordonnierC, Al-Shahi SalmanR, WardlawJ. Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting. Brain 2007;130:1988–2003.
4. ViswanathanA, ChabriatH. Cerebral microhemorrhage. Stroke 2006;37:550–5.
5. FanYH, MokVC, LamWWet al. Cerebral microbleeds and white matter changes in patients hospitalized with lacunar infarcts. J Neurol 2004;251:537–41.
6. ImaizumiT, HoritaY, ChibaMet al. Dot-like hemosiderin spots on gradient echo T2*-weighted magnetic resonance imaging are associated with past history of small vessel disease in patients with intracerebral hemorrhage. J Neuroimaging 2004;14:251–7.
7. LeeSH, BaeHJ, KwonSJet al. Cerebral microbleeds are regionally associated with intracerebral hemorrhage. Neurology 2004;62:72–6.
8. LeeSH, KwonSJ, KimKSet al. Cerebral microbleeds in patients with hypertensive stroke. Topographical distribution in the supratentorial area. J Neurol 2004;251:1183–9.
9. ImaizumiT, HonmaT, HoritaYet al. Dot-like hemosiderin spots are associated with past hemorrhagic strokes in patients with lacunar infarcts. J Neuroimaging 2005;15:157–63.
10. WerringDJ, CowardLJ, LosseffNAet al. Cerebral microbleeds are common in ischemic stroke but rare in TIA. Neurology 2005;65:1914–18.
11. ChoAH, LeeSB, HanSJet al. Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke. Neurology 2009;73:1645–8.
12. AlemanyM, StenborgA, TerentAet al. Coexistence of microhemorrhages and acute spontaneous brain hemorrhage: correlation with signs of microangiopathy and clinical data. Radiology 2006;238:240–7.
13. OvbiageleB, SaverJL, SanossianNet al. Predictors of cerebral microbleeds in acute ischemic stroke and TIA patients. Cerebrovasc Dis 2006;22:378–83.
14. JeonSB, KangDW, ChoAHet al. Initial microbleeds at MR imaging can predict recurrent intracerebral hemorrhage. J Neurol 2007;254:508–12.
15. HanJ, GaoP, LinYet al. Three-tesla magnetic resonance imaging study of cerebral microbleeds in patients with ischemic stroke. Neurolog Res 2009;31:900–3.
16. OrkenDN, KenangilG, UysalEet al. Cerebral microbleeds in ischemic stroke patients on warfarin treatment. Stroke 2009;40:3638–40.
17. StaalsJ, van OostenbruggeRJ, KnottnerusILet al. Brain microbleeds relate to higher ambulatory blood pressure levels in first-ever lacunar stroke patients. Stroke 2009;40:3264–8.
18. SunJ, SooYO, LamWWet al. Different distribution patterns of cerebral microbleeds in acute ischemic stroke patients with and without hypertension. Eur Neurol 2009;62:298–303.
19. KatoH, IzumiyamaM, IzumiyamaKet al. Silent cerebral microbleeds on T2*-weighted MRI: correlation with stroke subtype, stroke recurrence, and leukoaraiosis. Stroke 2002;33:1536–40.
20. GreenbergSM, VernooijMW, CordonnierCet al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol 2009;8:165–74.
21. AdamsHP, Jr., BendixenBH, KappelleLJet al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
22. BamfordJ, SandercockP, DennisMet al. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–6.
23. GaoT, WangY, ZhangZ. Silent cerebral microbleeds on susceptibility-weighted imaging of patients with ischemic stroke and leukoaraiosis. Neurolog Res 2008;30:272–6.
24. WardlawJM, LewisSC, KeirSLet al. Cerebral microbleeds are associated with lacunar stroke defined clinically and radiologically, independently of white matter lesions. Stroke 2006;37:2633–6.
25. LeeSH, BaeHJ, KoSBet al. Comparative analysis of the spatial distribution and severity of cerebral microbleeds and old lacunes. J Neurol Neurosurg Psychiatry 2004;75:423–7.
26. KnudsenKA, RosandJ, KarlukDet al. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology 2001;56:537–9.
27. HaglundM, PassantU, SjobeckMet al. Cerebral amyloid angiopathy and cortical microinfarcts as putative substrates of vascular dementia. Int J Geriatr Psychiatry 2006;21:681–7.
28. KimberlyWT, GilsonA, RostNSet al. Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology 2009;72:1230–5.
29. FazekasF, KleinertR, RoobGet al. Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. AJNR Am J Neuroradiol 1999;20:637–42.
30. RoobG, LechnerA, SchmidtRet al. Frequency and location of microbleeds in patients with primary intracerebral hemorrhage. Stroke 2000;31:2665–9.
31. SmithEE, NandigamKRN, ChenY-Wet al. MRI markers of small vessel disease in lobar and deep hemispheric intracerebral hemorrhage. Stroke 2010:41:1933–8.
32. LimJB, KimE. Silent microbleeds and old hematomas in spontaneous cerebral hemorrhages. J Korean Neurosurg Soc 2009;46:38–44.
33. CopenhaverBR, HsiaAW, MerinoJGet al. Racial differences in microbleed prevalence in primary intracerebral hemorrhage. Neurology 2008;71:1176–82.
34. LeeSH, KimBJ, RohJK. Silent microbleeds are associated with volume of primary intracerebral hemorrhage. Neurology 2006;66:430–2.
35. ImaizumiT, HonmaT, HoritaYet al. Hematoma size in deep intracerebral hemorrhage and its correlation with dot-like hemosiderin spots on gradient echo T2*-weighted MRI. J Neuroimaging 2006;16:236–42.
36. SchmahmannJD, SmithEE, EichlerFSet al. Cerebral white matter: neuroanatomy, clinical neurology, and neurobehavioral correlates. Ann N Y Acad Sci 2008;1142:266–309.
37. JeerakathilT, WolfPA, BeiserAet al. Cerebral microbleeds: prevalence and associations with cardiovascular risk factors in the Framingham Study. Stroke 2004;35:1831–5.
38. SveinbjornsdottirS, SigurdssonS, AspelundTet al. Cerebral microbleeds in the population based AGES–Reykjavik study: prevalence and location. J Neurol Neurosurg Psychiatry 2008;79:1002–6.
39. JeonSB, KwonSU, ChoAHet al. Rapid appearance of new cerebral microbleeds after acute ischemic stroke. Neurology 2009;73:1638–44.
40. JeongSW, JungKH, ChuKet al. Clinical and radiologic differences between primary intracerebral hemorrhage with and without microbleeds on gradient-echo magnetic resonance images. Arch Neurol 2004;61:905–9.
41. SmithEE, GurolME, EngJAet al. White matter lesions, cognition, and recurrent hemorrhage in lobar intracerebral hemorrhage. Neurology 2004;63:1606–12.
42. MaiaLF, VasconcelosC, SeixasSet al. Lobar brain hemorrhages and white matter changes: clinical, radiological and laboratorial profiles. Cerebrovasc Dis 2006;22:155–61.
43. ViswanathanA, GuichardJP, GschwendtnerAet al. Blood pressure and haemoglobin A1c are associated with microhaemorrhage in CADASIL: a two-centre cohort study. Brain 2006;129:2375–83.
44. DichgansM, HoltmannspotterM, HerzogJet al. Cerebral microbleeds in CADASIL: a gradient-echo magnetic resonance imaging and autopsy study. Stroke 2002;33:67–71.
45. CordonnierC, van der FlierWM, SluimerJDet al. Prevalence and severity of microbleeds in a memory clinic setting. Neurology 2006;66:1356–60.
46. PettersenJA, SathiyamoorthyG, GaoFQet al. Microbleed topography, leukoaraiosis, and cognition in probable Alzheimer disease from the Sunnybrook dementia study. Arch Neurol 2008;65:790–5.
47. GoosJD, KesterMI, BarkhofFet al. Patients with Alzheimer disease with multiple microbleeds: relation with cerebrospinal fluid biomarkers and cognition. Stroke 2009;40:3455–60.
48. van EsAC, van der GrondJ, de CraenAJet al. Risk factors for cerebral microbleeds in the elderly. Cerebrovasc Dis 2008;26:397–403.
49. JouventE, ViswanathanA, ManginJFet al. Brain atrophy is related to lacunar lesions and tissue microstructural changes in CADASIL. Stroke 2007;38:1786–90.
50. RomeroJM, SchaeferPW, GrantPEet al. Diffusion MR imaging of acute ischemic stroke. Neuroimaging Clin North Am 2002;12:35–53.
51. PierpaoliC, JezzardP, BasserPJet al. Diffusion tensor MR imaging of the human brain. Radiology 1996;201:637–48.
52. O’SullivanM, SummersPE, JonesDKet al. Normal-appearing white matter in ischemic leukoaraiosis: a diffusion tensor MRI study. Neurology 2001;57:2307–10.
53. ViswanathanA, PatelP, RahmanRet al. Tissue microstructural changes are independently associated with cognitive impairment in cerebral amyloid angiopathy. Stroke 2008;39:1988–92.
54. WardlawJM, FarrallA, ArmitagePAet al. Changes in background blood–brain barrier integrity between lacunar and cortical ischemic stroke subtypes. Stroke 2008;39:1327–32.
55. TopakianR, BarrickTR, HoweFAet al. Blood–brain barrier permeability is increased in normal-appearing white matter in patients with lacunar stroke and leucoaraiosis. J Neurol Neurosurg Psychiatry 2010;81:192–7.
56. HuynhTJ, MurphyB, PettersenJAet al. CT perfusion quantification of small-vessel ischemic severity. AJNR Am J Neuroradiol 2008;29:1831–6.
57. QiuC, CotchMF, SigurdssonSet al. Retinal and cerebral microvascular signs and diabetes: the Age Gene/Environment Susceptibility–Reykjavik study. Diabetes 2008;57:1645–50.
58. JohnsonKA. Amyloid imaging of Alzheimer's disease using Pittsburgh Compound B. Curr Neurol Neurosci Rep 2006;6:496–503.
59. LockhartA, LambJR, OsredkarTet al. PIB is a non-specific imaging marker of amyloid-beta (Abeta) peptide-related cerebral amyloidosis. Brain 2007;130:2607–15.
60. JohnsonKA, GregasM, BeckerJAet al. Imaging of amyloid burden and distribution in cerebral amyloid angiopathy. Ann Neurol 2007;62:229–34.
61. LyJV, DonnanGA, VillemagneVLet al. 11C-PIB binding is increased in patients with cerebral amyloid angiopathy-related hemorrhage. Neurology 2010;74:487–93.
62. GreenbergSM, EngJA, NingMet al. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. Stroke 2004;35:1415–20.
63. RosandJ,MuzikanskyA, KumarAet al. Spatial clustering of hemorrhages in probable cerebral amyloid angiopathy. Ann Neurol 2005;58:459–62.