Emerson L. Gasparetto MD, Presenter: Nothing to Disclose

L. Celso Cruz, Abstract Co-Author: Nothing to Disclose

Romeu Cortes Domingues MD, Abstract Co-Author: Nothing to Disclose

Roberto Cortes Domingues MD, Abstract Co-Author: Nothing to Disclose

Jorge Marcondes de Souza PhD, Abstract Co-Author: Nothing to Disclose

to compare the sensitivity of susceptibility-weighted images (SWI) with T2-weighted fast spin-echo (FSE) and gradient-echo (GRE) sequences in assigning the number of cerebral cavernous malformations (CCM) in patients with the familial form of the disease.

we studied fifteen patients with familial CCM. All patients underwent MR imaging at 1.5T scanner with the following sequences: T1- and T2-weighted FSE, T2-weighted GRE and SWI. SWI is an imaging method that combines a long echo time, high-resolution, fully flow-compensated, 3D GRE sequence with filtered phase information in each voxel. Two neuroradiologists were blindly and independently assigned to count the number of lesions in each sequence and compare all of them, based on equivalent slices of SWI, T2 FSE and T2 GRE. In addition, all the CCM were classified according to Zabramski classification in types 1 to 4. The final decisions were reached by consensus. The number of CCMs seen on T2*-weighted GRE, T2-weighted FSE and SWI sequences were compared with analysis of variance, followed by nonparametric Wilcoxon matched pairs test.

the difference between the number of lesions seen on the three sequences was statistically significant (P<0.0001). In addition, the number of CCMs was higher on T2-weighted GRE than on T2-weighted FSE (P=0.001). Finally, more lesions were seen on SWI than on T2-weighted GRE (P=0.001) and FSE (P=0.001) sequences. Regarding the Zabramski’s classification of the CCMs, there were 14 (2.3%) type 1 lesions, 29 (4.9%) type 2, 32 (5.4%) type 3 and 267 (44.9%) type 4 lesions. A substantial number of CCMs (n=253; 42.5%), which were seen only on the SWI sequence, could not be categorized based on Zabramski’s classification.

the sensitivity of SWI in assigning the number of CCMs in patients with the familial form of the disease is significantly higher than T2-weighted FSE and GRE sequences. In our series, the SWI showed 73% more lesions than T2-weighted GRE images. Also, because the number of lesions seen on SWI was higher than T2-weighted GRE images, we suggest a modification on the Zabramski’s classification of type 4 lesions.

Better sequence to evaluate CCMs

Gasparetto, E, Cruz, L, Domingues, R, Domingues, R, de Souza, J, Susceptibility-weighted Imaging for the Evaluation of Patients with Familial Cerebral Cavernous Malformations: A Comparison with T2-weighted Fast Spin-Echo and Gradient-Echo Sequences.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5016265.html