Silent Cerebral Microbleeds on T2*-Weighted MRI: Correlation with Stroke Subtype, Stroke Recurrence, and Leukoaraiosis

Background and Purpose— Gradient-echo T2*-weighted MRI is uniquely sensitive to detect silent, old hemosiderin deposits, but the clinical significance of such “microbleeds” remains to be determined. Therefore, we investigated the incidence and the number of microbleeds among different stroke subtypes and the correlation with stroke recurrence and the severity of leukoaraiosis. Methods— This study consisted of 213 patients (73.5±9.1 years old, 104 men and 109 women), who were classified according to stroke subtypes into atherothrombotic infarction (24 patients), cardioembolic infarction (23 patients), lacunar infarction (66 patients), intracerebral hemorrhage (35 patients), and control (65 patients) groups. Gradient-echo T2*-weighted MRI was performed with a 1.5 T system, and asymptomatic microbleeds were located and counted. Results— The incidence and the number of microbleeds were significantly greater in patients with intracerebral hemorrhage (71.4% and 9.1±13.8, respectively) and lacunar infarction (62.1% and 7.4±16.1) compared with patients with cardioembolic infarction (30.4% and 2.5±5.6), atherothrombotic infarction (20.8% and 0.63±1.53), and controls (7.7% and 0.09±0.34). There was a correlation between the number of microbleeds and the severity of periventricular hyperintensity (r =0.626, P <0.0001). There was also a correlation between the number of microbleeds and the number of intracerebral hemorrhages (r =0.689, P <0.0001) or lacunar infarctions (r =0.514, P <0.0001). The locations of microbleeds were subcortical white matter (31.8%), thalamus (24.8%), basal ganglia (19.8%), brain stem (12.0%), and cerebellum (11.7%). Conclusions— The findings suggest that microbleeds on T2*-weighted MRI are an indicator of advanced small artery disease of the brain with an increased risk for bleeding. This result should be taken into consideration when treating patients with stroke, and further studies are required.

[1]  J. Hatazawa,et al.  Assessment of lacunar hemorrhage associated with hypertensive stroke by echo-planar gradient-echo T2*-weighted MRI. , 2000, Stroke.

[2]  P Kapeller,et al.  MRI evidence of past cerebral microbleeds in a healthy elderly population , 1999, Neurology.

[3]  Fisher Cm,et al.  Lacunes: Small, deep cerebral infarcts , 1965 .

[4]  F. Fazekas,et al.  Magnetic resonance imaging of cerebral microbleeds. , 2000, Current opinion in neurology.

[5]  F. Verheugt,et al.  A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin , 1997, Annals of neurology.

[6]  H P Hartung,et al.  Frequency and Location of Microbleeds in Patients With Primary Intracerebral Hemorrhage , 2000, Stroke.

[7]  C. Benesch,et al.  Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. , 1999, Stroke.

[8]  J. V. van Swieten,et al.  Periventricular lesions in the white matter on magnetic resonance imaging in the elderly. A morphometric correlation with arteriolosclerosis and dilated perivascular spaces. , 1991, Brain : a journal of neurology.

[9]  C. Maurage,et al.  CADASIL: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy , 1997, Journal of neuropathology and experimental neurology.

[10]  Eduard Kraft,et al.  MRI detection of new hemorrhages: Potential marker of progression in cerebral amyloid angiopathy , 1999, Neurology.

[11]  P. Whelton,et al.  Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. , 1998, JAMA.

[12]  H. Vinters.  Cerebral amyloid angiopathy. A critical review. , 1987, Stroke.

[13]  T. Yamaguchi.  Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation : a multicenter, prospective, randomized trial. Japanese Nonvalvular Atrial Fibrillation-Embolism Secondary Prevention Cooperative Study Group. , 2000, Stroke.

[14]  K. Matsubayashi,et al.  Incidental Brain Lesions on Magnetic Resonance Imaging and Neurobehavioral Functions in the Apparently Healthy Elderly , 1992, Stroke.

[15]  J. Stam,et al.  Silent intracerebral microhemorrhages in patients with ischemic stroke , 1998, Annals of neurology.

[16]  H. Ellis.  stroke , 1997, The Lancet.

[17]  J. Gorter,et al.  Major bleeding during anticoagulation after cerebral ischemia , 1999, Neurology.

[18]  P Kapeller,et al.  Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. , 1999, AJNR. American journal of neuroradiology.

[19]  C. Fisher.  Cerebral miliary aneurysms in hypertension. , 1972, The American journal of pathology.

[20]  M. Ferrari,et al.  Cerebral microbleeds in CADASIL , 2001, Neurology.

[21]  Fisher Cm.  Cerebral Miliary Aneurysms in Hypertension , 1972 .

[22]  Robert A. Zimmerman,et al.  Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. , 1990, Stroke.

[23]  J. Cairns,et al.  Prevention of stroke in patients with nonvalvular atrial fibrillation , 1998, Neurology.

[24]  S K Hilal,et al.  Multifocal hypointense cerebral lesions on gradient-echo MR are associated with chronic hypertension. , 1996, AJNR. American journal of neuroradiology.

[25]  F. Fazekas,et al.  MR of cerebral abnormalities concomitant with primary intracerebral hematomas. , 1996, AJNR. American journal of neuroradiology.

[26]  寒河江純平,et al.  [CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)]. , 1997, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[27]  S. Finklestein,et al.  Petechial hemorrhages accompanying lobar hemorrhage , 1996, Neurology.