Tan Rachel, Spring Kevin J, Killingsworth Murray, Bhaskar Sonu
Global Health Neurology Lab, Sydney, NSW 2150, Australia.
UNSW Medicine and Health, South Western Sydney Clinical Campuses, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
Medicina (Kaunas). 2025 Aug 30;61(9):1566. doi: 10.3390/medicina61091566.
: Cerebral microbleeds (CMBs) are increasingly being considered as potential biomarkers of small vessel disease and cerebral vulnerability, particularly in patients with acute ischemic stroke (AIS). Accurate detection is crucial for prognosis and therapeutic decision-making, yet the relative utility of susceptibility-weighted imaging (SWI) versus T2*-weighted imaging (T2*) remains uncertain. Materials and Methods: We conducted a systematic review and meta-analysis (SPOT-CMB, study) of 80 studies involving 28,383 AIS patients. Pooled prevalence of CMBs was estimated across imaging modalities (SWI, T2*, and both), and stratified analyses examined variation by demographic, clinical, and imaging parameters. Meta-analytic odds ratios assessed associations between CMB presence and key outcomes: symptomatic intracerebral hemorrhage (sICH), hemorrhagic transformation (HT), and poor functional outcome (modified Rankin Scale score 3-6) at 90 days. Diagnostic performance was assessed using summary receiver operating characteristic curves. : Pooled CMB prevalence was higher with SWI (36%; 95% CI 31-41) than T2* (25%; 95% CI 22-28). CMB presence was associated with increased odds of sICH (OR 2.22; 95% CI 1.56-3.16), HT (OR 1.33; 95% CI 1.01-1.75), and poor 90-day outcome (OR 1.61; 95% CI 1.39-1.86). However, prognostic performance was modest, with low sensitivity (e.g., AUC for sICH: 0.29) and low diagnostic odds ratios. SWI outperformed T2* in detection but offered limited prognostic gain. Access to SWI remains limited in many settings, posing challenges for global implementation. : SWI detects CMBs more frequently than T2* in AIS patients and shows stronger associations with adverse outcomes, supporting its value for risk stratification. However, prognostic accuracy remains limited, and our GRADE appraisal indicated only moderate certainty for functional outcomes, with lower certainty for diagnostic accuracy due to heterogeneity and imprecision. These findings highlight the clinical utility of SWI but underscore the need for standardized imaging protocols and high-quality prospective studies.
脑微出血（CMBs）越来越被视为小血管疾病和脑易损性的潜在生物标志物，尤其是在急性缺血性卒中（AIS）患者中。准确检测对于预后和治疗决策至关重要，但磁敏感加权成像（SWI）与T2加权成像（T2）的相对效用仍不确定。材料与方法：我们对80项涉及28383例AIS患者的研究进行了系统评价和荟萃分析（SPOT-CMB研究）。估计了各种成像方式（SWI、T2以及两者）下CMBs的合并患病率，并通过人口统计学、临床和成像参数进行分层分析。荟萃分析比值比评估了CMB存在与关键结局之间的关联：有症状性脑出血（sICH）、出血性转化（HT）以及90天时不良功能结局（改良Rankin量表评分3 - 6）。使用汇总的受试者工作特征曲线评估诊断性能。：SWI检测到的CMB合并患病率（36%；95%可信区间31 - 41）高于T2（25%；95%可信区间22 - 28）。CMB的存在与sICH（比值比2.22；95%可信区间1.56 - 3.16）、HT（比值比1.33；95%可信区间1.01 - 1.75）以及90天不良结局（比值比1.61；95%可信区间1.39 - 1.86）的几率增加相关。然而，预后性能一般，敏感性较低（例如，sICH的曲线下面积：0.29）且诊断比值比低。SWI在检测方面优于T2*，但预后获益有限。在许多情况下，SWI的获取仍然有限，这给全球实施带来了挑战。：在AIS患者中，SWI检测CMBs比T2*更频繁，并且与不良结局的关联更强，支持其在风险分层中的价值。然而，预后准确性仍然有限，我们的GRADE评估表明，对于功能结局只有中等确定性，由于异质性和不精确性，诊断准确性的确定性较低。这些发现突出了SWI的临床效用，但强调了标准化成像方案和高质量前瞻性研究的必要性。
