# Improved MRI Detection of Cerebral Microbleeds with Novel Susceptibility Mapping

> **NIH NIH R21** · BETH ISRAEL DEACONESS MEDICAL CENTER · 2021 · $223,414

## Abstract

Cerebral microbleeds (CMBs) are small brain bleeds (less than 1 cm on MRI, and not visible on CT). Their
presence is used to make multiple diagnoses (cerebral amyloid angiopathy, traumatic brain injury, acute and
chronic hypertensive intracranial hemorrhage, the Alzheimer's drug complication ARIA-H, etc.), and is
associated with increased risk of larger brain bleeds, cognitive decline, and aneurysm rupture. They are also
associated with worse outcomes for multiple diseases, including brain bleeds in stroke patients after clot
busting drugs are given and worse disability after brain clot removal in stroke, relative to patients without
CMBs. Detection of CMBs plays a major role in patient therapeutic management based on their number and
where in the brain they are found. Unfortunately, the number and location of detectable CMBs are highly
variable depending on the type of MRI imaging used. For example, while 3T SWI imaging is the most sensitive
of clinically available CMB imaging methods, studies correlating radiology imaging with brain tissue
examination have demonstrated that up to 75% of CMBs in tissue are not detected by 3T SWI MRI.
Additionally, SWI has been shown to have difficulty distinguishing CMBs from calcification, which is a common
CMB mimic.
Much of the technical variability seen in SWI and similar clinically used MRI techniques is not present in a
newer MRI technique called quantitative susceptibility mapping (QSM). However, most QSM imaging requires
the skull to be masked (mQSM), resulting in omission of random parts of the brain in the resultant images. Our
work has shown that a newer kind of QSM, that does not require the masking (called pQSM), shows much of
the brain not seen on mQSM images. We also showed that CMBs were present in some of the areas of brain
that are visible on pQSM but not mQSM images.
Typically, the MRIs that diagnose CMBs are read by neuroradiologists. The goal of this project is to study
differences in how neuroradiologists read pQSM and SWI images for evaluating CMBs, and to see if those
differences would lead to different patient care, related to the number and / or location of CMBs identified. We
have access to data from a group of patients admitted to the hospital with larger bleeds, who received MRIs as
part of their care that included the raw data needed to make SWI and pQSM images as well as CT scans that
show their large brain bleed and areas of calcification. We plan to use this data to make SWI and pQSM
images for a panel of reader neuroradiologists to review for CMBs. Because we cannot get brain tissue from
these patients, we recruited additional neuroradiologists to serve as an expert panel to select areas on the SWI
and pQSM images to classify as CMB or not CMB, to serve as a gold standard. The reader neuroradiologists
will then review these areas marked by the expert panel for CMBs.

## Key facts

- **NIH application ID:** 10191060
- **Project number:** 5R21NS109728-02
- **Recipient organization:** BETH ISRAEL DEACONESS MEDICAL CENTER
- **Principal Investigator:** Salil Soman
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $223,414
- **Award type:** 5
- **Project period:** 2020-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10191060

## Citation

> US National Institutes of Health, RePORTER application 10191060, Improved MRI Detection of Cerebral Microbleeds with Novel Susceptibility Mapping (5R21NS109728-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10191060. Licensed CC0.

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