Rauschenbach Laurèl, Santos Alejandro N, Rodemerk Jan, Gull Hanah H, Dinger Thiemo F, Engel Adrian, Schüssler Maximilian, Li Yan, Darkwah Oppong Marvin, Jabbarli Ramazan, Frank Benedikt, Forsting Michael, Wrede Karsten H, Sure Ulrich, Dammann Philipp
Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
Center for Translational Neuro- and Behavioral Sciences, C-TNBS, University Duisburg Essen, Essen, Germany.
Neuroradiology. 2025 Jun 13. doi: 10.1007/s00234-025-03666-2.
Hemosiderin-sensitive MRI sequences are commonly utilized for microbleed identification in cerebral cavernous malformations (CCM). Efficacy of susceptibility-weighted (SWI) and gradient-echo T2*-weighted imaging (GRE-T2*) sequences in detecting CCM-associated developmental venous anomalies (DVA) remains uncertain.
We conducted a retrospective review of our institutional CCM database. Inclusion criteria comprised baseline characteristics and MRI datasets involving contrast-enhanced T1 (CE-T1), T2, and SWI or GRE-T2* sequences. The presence of CCM-related DVA was determined utilizing CE-T1 imaging. A subgroup of 200 patients, evenly distributed with or without DVA, underwent random selection for analysis, with 50 patients each having SWI and GRE-T2* imaging. The presence of DVA was evaluated by two blinded neuroradiologists based on SWI or GRE-T2* sequences. Interrater agreement, sensitivity, and specificity values for SWI and GRE-T2* sequences were analyzed.
Imaging assessment demonstrated observer agreement in 76% of the SWI sequences (K = 0.51, p <0.001) and 82% of the GRE-T2* images (K = 0.39, p <0.001). While SWI sequences exhibited a sensitivity of 81.4% and a specificity of 60.6%, GRE-T2* sequences showed a sensitivity of 19.1% and a specificity of 97.5%. Misdiagnoses were frequent in small vessel DVAs, whereas large vessel DVAs were associated with higher diagnostic accuracy in both SWI and GRE-T2* sequences (p =0.002).
Evaluation of SWI and GRE-T2* sequences for assessing CCM-related DVA appears less effective than the routine use of CE-T1 sequences. The use of contrast agents still appears necessary for detailed diagnostics and appropriate surgery planning.
含铁血黄素敏感的磁共振成像（MRI）序列常用于脑海绵状畸形（CCM）中微出血的识别。磁敏感加权成像（SWI）和梯度回波T2加权成像（GRE-T2）序列在检测CCM相关的发育性静脉异常（DVA）方面的有效性仍不确定。
我们对本机构的CCM数据库进行了回顾性研究。纳入标准包括基线特征和涉及对比增强T1（CE-T1）、T2以及SWI或GRE-T2序列的MRI数据集。利用CE-T1成像确定CCM相关DVA的存在。随机选择200例患者组成一个亚组进行分析，这些患者中有无DVA的分布均匀，其中50例患者分别接受了SWI和GRE-T2成像。两名不知情的神经放射科医生根据SWI或GRE-T2序列评估DVA的存在情况。分析SWI和GRE-T2序列的观察者间一致性、敏感性和特异性值。
影像学评估显示，SWI序列的观察者间一致性为76%（K = 0.51，p <0.001），GRE-T2图像的观察者间一致性为82%（K = 0.39，p <0.001）。SWI序列的敏感性为81.4%，特异性为60.6%，而GRE-T2序列的敏感性为19.1%，特异性为97.5%。小血管DVA的误诊很常见，而大血管DVA在SWI和GRE-T2*序列中均具有较高的诊断准确性（p = 0.002）。
评估SWI和GRE-T2*序列以检测CCM相关DVA似乎不如常规使用CE-T1序列有效。对于详细诊断和适当的手术规划，使用造影剂似乎仍然是必要的。
