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Cerebral Microbleeds: Imaging and Clinical Significance
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Affidea Ctr Diagnost Radiol Carouge CDRC, Geneva, Switzerland; Univ Geneva, Fac Med, Geneva, Switzerland; Univ Hosp Freiburg, Dept Neuroradiol, Freiburg, Germany .ORCID iD: 0000-0001-7433-0203
Erasmus MC, Dept Radiol & Nucl Med, Rotterdam, Netherlands; Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands.
Vrije Univ Amsterdam, Med Ctr, Amsterdam Neurosci, Dept Radiol & Nucl Med, Amsterdam, Netherlands.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.ORCID iD: 0000-0001-6308-1387
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2018 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 287, no 1, p. 11-28Article, review/survey (Refereed) Published
Abstract [en]

Cerebral microbleeds (CMBs), also referred to as microhemorrhages, appear on magnetic resonance (MR) images as hypointense foci notably at T2*-weighted or susceptibility-weighted (SW) imaging. CMBs are detected with increasing frequency because of the more widespread use of high magnetic field strength and of newer dedicated MR imaging techniques such as three-dimensional gradient-echo T2*-weighted and SW imaging. The imaging appearance of CMBs is mainly because of changes in local magnetic susceptibility and reflects the pathologic iron accumulation, most often in perivascular macrophages, because of vasculopathy. CMBs are depicted with a true-positive rate of 48%–89% at 1.5 T or 3.0 T and T2*-weighted or SW imaging across a wide range of diseases. False-positive “mimics” of CMBs occur at a rate of 11%–24% and include microdissections, microaneurysms, and microcalcifications; the latter can be differentiated by using phase images. Compared with postmortem histopathologic analysis, at least half of CMBs are missed with premortem clinical MR imaging. In general, CMB detection rate increases with field strength, with the use of three-dimensional sequences, and with postprocessing methods that use local perturbations of the MR phase to enhance T2* contrast. Because of the more widespread availability of high-field-strength MR imaging systems and growing use of SW imaging, CMBs are increasingly recognized in normal aging, and are even more common in various disorders such as Alzheimer dementia, cerebral amyloid angiopathy, stroke, and trauma. Rare causes include endocarditis, cerebral autosomal dominant arteriopathy with subcortical infarcts, leukoencephalopathy, and radiation therapy. The presence of CMBs in patients with stroke is increasingly recognized as a marker of worse outcome. Finally, guidelines for adjustment of anticoagulant therapy in patients with CMBs are under development.

Place, publisher, year, edition, pages
2018. Vol. 287, no 1, p. 11-28
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Radiology, Nuclear Medicine and Medical Imaging
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URN: urn:nbn:se:uu:diva-346992DOI: 10.1148/radiol.2018170803ISI: 000427992600003PubMedID: 29558307OAI: oai:DiVA.org:uu-346992DiVA, id: diva2:1192656
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-07-19Bibliographically approved

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Haller, SvenLarsson, Elna-Marie

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