Kinkade Serena, Li Hui, Hage Stephanie, Koskimäki Janne, Stadnik Agnieszka, Lee Justine, Shenkar Robert, Papaioannou John, Flemming Kelly D, Kim Helen, Torbey Michel, Huang Judy, Carroll Timothy J, Girard Romuald, Giger Maryellen L, Awad Issam A
Departments of1Neurological Surgery and.
2Diagnostic Radiology, University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
J Neurosurg. 2025 Jul 4:1-8. doi: 10.3171/2025.3.JNS243051.
Features of new bleeding on conventional imaging in cerebral cavernous malformations (CCMs) often disappear after several weeks, yet the risk of rebleeding persists long thereafter. Increases in mean lesional quantitative susceptibility mapping (QSM) ≥ 6% on MRI during 1 year of prospective surveillance have been associated with new symptomatic hemorrhage (SH) during that period. The authors hypothesized that QSM at a single time point reflects features of hemorrhage in the prior year or potential bleeding in the subsequent year. Twenty-eight features were extracted from 265 QSM acquisitions in 120 patients enrolled in a prospective trial readiness project, and machine learning methods examined associations with SH and biomarker bleed (QSM increase ≥ 6%) in prior and subsequent years. QSM features including sum variance, variance, and correlation had lower average values in lesions with SH in the prior year (p < 0.05, false discovery rate corrected). A support-vector machine classifier recurrently selected sum average, mean lesional QSM, sphericity, and margin sharpness features to distinguish biomarker bleeds in the prior year (area under the curve = 0.61, 95% CI 0.52-0.70; p = 0.02). No QSM features were associated with a subsequent bleed. These results provide proof of concept that machine learning may derive features of QSM reflecting prior hemorrhagic activity, meriting further investigation. Clinical trial registration no.: NCT03652181 (ClinicalTrials.gov).
脑海绵状血管畸形(CCM)中传统成像上新出血的特征通常在几周后消失,但再出血风险在此后很长时间内持续存在。在前瞻性监测的1年中,MRI上平均病变定量磁化率映射(QSM)增加≥6%与该期间新的症状性出血(SH)相关。作者推测,单个时间点的QSM反映了前一年的出血特征或下一年的潜在出血情况。从参与前瞻性试验准备项目的120例患者的265次QSM采集数据中提取了28个特征,并采用机器学习方法研究了与前一年和后一年的SH及生物标志物出血(QSM增加≥6%)的相关性。在前一年发生SH的病变中,包括总和方差、方差和相关性在内的QSM特征的平均值较低(p<0.05,经错误发现率校正)。支持向量机分类器反复选择总和平均值、平均病变QSM、球形度和边缘清晰度特征来区分前一年的生物标志物出血(曲线下面积=0.61,95%CI 0.52-0.70;p=0.02)。没有QSM特征与随后的出血相关。这些结果提供了概念验证,即机器学习可能得出反映先前出血活动的QSM特征,值得进一步研究。临床试验注册号:NCT03652181(ClinicalTrials.gov)。