title: MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength.
abstract: OBJECTIVE
  The emergence of cerebral microbleeds (CMB) as common MR imaging findings raises the question of how MR imaging parameters influence CMB detection. To evaluate the effects of modified gradient recalled-echo (GRE) MR imaging methods, we performed an analysis of sequence, section thickness, and field strength on CMB imaging properties and detection in subjects with cerebral amyloid angiopathy (CAA), a condition associated with microhemorrhage.
  
  
  METHODS
  Multiple MR images were obtained from subjects with probable CAA, with varying sequences (GRE versus susceptibility-weighted imaging [SWI]), section thicknesses (1.2-1.5 versus 5 mm), and magnetic field strengths (1.5T versus 3T). Individual CMB were manually identified and analyzed for contrast index (lesion intensity normalized to normal-appearing white matter signal intensity) and diameter. CMB counts were compared between 1.5T thick-section GRE and thin-section SWI for 3 subjects who underwent both protocols in the same scanning session.
  
  
  RESULTS
  With other parameters constant, use of SWI, thinner sections, and a higher field strength yielded medium-to-large gains in CMB contrast index (CI; Cohen d 0.71-1.87). SWI was also associated with small increases in CMB diameter (Cohen d <0.3). Conventional thick-section GRE identified only 33% of CMB (103 of 310) seen on thin-section SWI. Lesions prospectively identified on GRE had significantly greater CI and diameter measured on the GRE image than those not prospectively identified.
  
  
  CONCLUSIONS
  The examined alternatives to conventional GRE MR imaging yield substantially improved CMB contrast and sensitivity for detection. Future studies based on these techniques will most likely yield even higher prevalence estimates for CMB.
authors.affiliation: Hemorrhagic Stroke Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: R N K
authors.initials: RN
authors.lastname: Nandigam
authors.forename: A
authors.initials: A
authors.lastname: Viswanathan
authors.forename: P
authors.initials: P
authors.lastname: Delgado
authors.forename: M E
authors.initials: ME
authors.lastname: Skehan
authors.forename: E E
authors.initials: EE
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Rosand
authors.forename: S M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: B C
authors.initials: BC
authors.lastname: Dickerson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016657:Cerebral Amyloid Angiopathy / Q000453:epidemiology / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies