title: Radiologic-Histopathologic Correlation of Cerebral Microbleeds Using Pre-Mortem and Post-Mortem MRI.
abstract: BACKGROUND
  Cerebral microbleeds (CMB), also known as cerebral microhemorrhages, are small areas of susceptibility on brain magnetic resonance imaging (MRI), that are increasingly detected due to the higher availability of high-field MRI systems and dedicated pulse sequences. The prevalence of CMBs increases in cases with cognitive decline. The current investigation assessed the poorly investigated radiologic-histopathologic correlation of CMBs on MRI.
  
  
  METHODS
  The local ethical committee approved the current investigation. We retrospectively assessed a consecutive series of 1303 autopsy cases hospitalized in Geneva University Hospitals between 2000-2014. Of 112 cases with pre-mortem T2* sequences, we included 25 cases (mean age 77.3 ± 9.6, 9 females) with at least one CMB. We compared pre-mortem CMBs with targeted histopathology and post-mortem MRI.
  
  
  RESULTS
  25 cases had 31 CMB lesions detected by pre-mortem MRI. 25 additional CMB were detected on histopathology. 4 CMBs on pre-mortem MRI were false positives, resulting in a total of 52 CMBs. 27 CMBs on pre-mortem MRI were confirmed on histopathology, corresponding to a sensitivity or true positive rate of 51.9% (95% CI 37.6-66.0%). The false negative rate of pre-mortem MRI was 48.1% (95% CI 34.0-62.4%). Post-mortem MRI showed only 3 cases with additional CMBs. Overall, pre-mortem MRI significantly underestimated CMBs (p = 0.0001).
  
  
  CONCLUSIONS
  Routine clinical brain MRI underestimates the prevalence of CMBs by approximately 50%, and 12% of radiologic pre-mortem MRI CMBs were false positives. Post-mortem MRI confirmed that this discordance is not explained by microbleeds occurring after the pre-mortem MRI.
authors.affiliation: Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Carouge, Switzerland.|Medical School of the University of Geneva, Geneva, Switzerland.|Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.|Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Sven
authors.identifier: http://orcid.org/0000-0001-7433-0203
authors.initials: S
authors.lastname: Haller
authors.affiliation: Medical School of the University of Geneva, Geneva, Switzerland.|Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Montandon
authors.affiliation: Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Lazeyras
authors.affiliation: Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
authors.forename: Max
authors.initials: M
authors.lastname: Scheffler
authors.affiliation: Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Meckel
authors.affiliation: Medical School of the University of Geneva, Geneva, Switzerland.|Division of Geriatrics, Department of internal medicine, rehabilitation and geriatrics, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Francois R
authors.initials: FR
authors.lastname: Herrmann
authors.affiliation: Medical School of the University of Geneva, Geneva, Switzerland.|Medical Direction, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Panteleimon
authors.initials: P
authors.lastname: Giannakopoulos
authors.affiliation: Medical School of the University of Geneva, Geneva, Switzerland.|Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Enikö
authors.initials: E
authors.lastname: Kövari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology*; D003933:Diagnosis; D005260:Female; D006652:Histological Techniques; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies