title: Imaging Cerebral Microhemorrhages in Military Service Members with Chronic Traumatic Brain Injury.
abstract: OBJECTIVE
  To detect cerebral microhemorrhages in military service members with chronic traumatic brain injury by using susceptibility-weighted magnetic resonance (MR) imaging. The longitudinal evolution of microhemorrhages was monitored in a subset of patients by using quantitative susceptibility mapping.
  
  
  METHODS
  The study was approved by the Walter Reed National Military Medical Center institutional review board and is compliant with HIPAA guidelines. All participants underwent two-dimensional conventional gradient-recalled-echo MR imaging and three-dimensional flow-compensated multiecho gradient-recalled-echo MR imaging (processed to generate susceptibility-weighted images and quantitative susceptibility maps), and a subset of patients underwent follow-up imaging. Microhemorrhages were identified by two radiologists independently. Comparisons of microhemorrhage number, size, and magnetic susceptibility derived from quantitative susceptibility maps between baseline and follow-up imaging examinations were performed by using the paired t test.
  
  
  RESULTS
  Among the 603 patients, cerebral microhemorrhages were identified in 43 patients, with six excluded for further analysis owing to artifacts. Seventy-seven percent (451 of 585) of the microhemorrhages on susceptibility-weighted images had a more conspicuous appearance than on gradient-recalled-echo images. Thirteen of the 37 patients underwent follow-up imaging examinations. In these patients, a smaller number of microhemorrhages were identified at follow-up imaging compared with baseline on quantitative susceptibility maps (mean ± standard deviation, 9.8 microhemorrhages ± 12.8 vs 13.7 microhemorrhages ± 16.6; P = .019). Quantitative susceptibility mapping-derived quantitative measures of microhemorrhages also decreased over time: -0.85 mm(3) per day ± 1.59 for total volume (P = .039) and -0.10 parts per billion per day ± 0.14 for mean magnetic susceptibility (P = .016).
  
  
  CONCLUSIONS
  The number of microhemorrhages and quantitative susceptibility mapping-derived quantitative measures of microhemorrhages all decreased over time, suggesting that hemosiderin products undergo continued, subtle evolution in the chronic stage.
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Karl
authors.initials: K
authors.lastname: Soderlund
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Justin S
authors.initials: JS
authors.lastname: Senseney
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: David
authors.initials: D
authors.lastname: Joy
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Yeh
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: John
authors.initials: J
authors.lastname: Ollinger
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Elyssa B
authors.initials: EB
authors.lastname: Sham
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Tian
authors.initials: T
authors.lastname: Liu
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Terrence R
authors.initials: TR
authors.lastname: Oakes
authors.affiliation: From the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, 4860 S Palmer Rd, Bethesda, MD 20889-5649 (W.L., K.S., J.S.S., D.J., P.H.Y., J.O., E.B.S., T.R.O., G.R.); Center for Neuroscience and Regenerative Medicine, Bethesda, Md (D.J., T.R.O., G.R.); The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (D.J.); Biomedical Engineering Department, Cornell University, New York, NY (T.L., Y.W.); and The NorthTide Group, Sterling, Va (W.L., E.B.S.).
authors.forename: Gerard
authors.initials: G
authors.lastname: Riedy
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel