Saito Tsukasa, Kawamura Yuichiro, Sato Nobuyuki, Sugiyama Eitaro, Okada Motoi, Takeuchi Toshiharu, Akasaka Kazumi, Hasebe Naoyuki
Department of Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Asahikawa, Japan.
Department of Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Asahikawa, Japan.
J Stroke Cerebrovasc Dis. 2018 Feb;27(2):315-320. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.001. Epub 2017 Sep 29.
Cerebral microbleeds (CMBs) are refined neuroimaging findings detected on T2*-weighted gradient echo (GRE) magnetic resonance imaging (MRI) and are widely accepted as an important marker of the vulnerability of cerebral small vessels. It is necessary to further clarify the natural history of CMBs by a longitudinal study. This study aimed to reveal the natural history of CMBs and find a better way to track CMBs by a prospective long-term observation.
We performed yearly brain MRI assessments for 7 or more years in 8 nonvalvular atrial fibrillation Japanese outpatients with CMBs detected in the baseline MRI. We began to use a 3.0T MRI scanner from 2012 as well.
We followed up 3 patients for 9 years, 2 for 8 years, and 3 for 7 years. In all patients, the CMBs at baseline did not disappear during the follow-up period. Importantly, the CMB in 1 patient seemed to disappear during the sixth imaging using 1.5T T2*-weighted GRE but was detected again during the seventh imaging with 3.0T susceptibility weighted imaging and ninth imaging with 3.0T T2* GRE. Moreover, in a patient implanted with a pacemaker, which is only applicable for 1.5T MRI at present, the CMB seemed to disappear and appeared once again with a 1.5T T2*-weighted GRE at a slice thickness of 2.5 mm instead of 5 mm.
From this prospective study, we obtained 2 absolutely new findings that CMBs remained for as long as 9 years and a high-field or thin-slice MRI can detect concealed CMBs.
脑微出血（CMBs）是在T2 *加权梯度回波（GRE）磁共振成像（MRI）上检测到的精细神经影像学表现，被广泛认为是脑小血管易损性的重要标志物。有必要通过纵向研究进一步阐明CMBs的自然病史。本研究旨在通过前瞻性长期观察揭示CMBs的自然病史，并找到更好的追踪CMBs的方法。
我们对8名在基线MRI中检测到CMBs的非瓣膜性心房颤动日本门诊患者进行了为期7年或更长时间的年度脑MRI评估。从2012年起我们也开始使用3.0T MRI扫描仪。
我们对3例患者进行了9年的随访，2例进行了8年的随访，3例进行了7年的随访。在所有患者中，基线时的CMBs在随访期间均未消失。重要的是，1例患者的CMB在使用1.5T T2 *加权GRE进行的第六次成像时似乎消失了，但在使用3.0T磁敏感加权成像进行的第七次成像和使用3.0T T2 * GRE进行的第九次成像时再次被检测到。此外，在一名植入起搏器的患者中（目前该起搏器仅适用于1.5T MRI），CMB似乎消失了，并在切片厚度为2.5 mm而非5 mm的1.5T T2 *加权GRE成像时再次出现。
通过这项前瞻性研究，我们获得了两个全新的发现，即CMBs可长达9年持续存在，并且高场或薄层MRI可以检测到隐匿的CMBs。
