Open AccessPerfusion and permeability as diagnostic biomarkers of cavernous angioma with symptomatic hemorrhage
Author(s) -
Je Yeong Sone,
Yan Li,
Nicholas Hobson,
Sharbel Romanos,
Abhinav Srinath,
Seán B. Lyne,
Abdallah Shkoukani,
Julián CarriónPenagos,
Agnieszka Stadnik,
Kristina Piedad,
Rhonda Lightle,
Thomas Moore,
Ying Li,
Dehua Bi,
Robert Shenkar,
Timothy J. Carroll,
Yuan Ji,
Romuald Girard
Publication year - 2021
Publication title -
journal of cerebral blood flow and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.167
H-Index - 193
eISSN - 1559-7016
pISSN - 0271-678X
DOI - 10.1177/0271678x211020587
Subject(s) - medicine , biomarker , perfusion , radiology , perfusion scanning , imaging biomarker , neuroradiology , magnetic resonance imaging , biochemistry , chemistry , neurology , psychiatry
Cavernous angiomas with symptomatic hemorrhage (CASH) have a high risk of rebleeding, and hence an accurate diagnosis is needed. With blood flow and vascular leak as established mechanisms, we analyzed perfusion and permeability derivations of dynamic contrast-enhanced quantitative perfusion (DCEQP) MRI in 745 lesions of 205 consecutive patients. Thirteen respective derivations of lesional perfusion and permeability were compared between lesions that bled within a year prior to imaging (N = 86), versus non-CASH (N = 659) using machine learning and univariate analyses. Based on logistic regression and minimizing the Bayesian information criterion (BIC), the best diagnostic biomarker of CASH within the prior year included brainstem lesion location, sporadic genotype, perfusion skewness, and high-perfusion cluster area (BIC = 414.9, sensitivity = 74%, specificity = 87%). Adding a diagnostic plasma protein biomarker enhanced sensitivity to 100% and specificity to 85%. A slightly modified derivation achieved similar accuracy (BIC = 321.6, sensitivity = 80%, specificity = 82%) in the cohort where CASH occurred 3-12 months prior to imaging after signs of hemorrhage would have disappeared on conventional MRI sequences. Adding the same plasma biomarker enhanced sensitivity to 100% and specificity to 87%. Lesional blood flow on DCEQP may distinguish CASH after hemorrhagic signs on conventional MRI have disappeared and are enhanced in combination with a plasma biomarker.