Vascular permeability and iron deposition biomarkers in longitudinal follow-up of cerebral cavernous malformations

Romuald Girard, Maged D. Fam, Hussein A. Zeineddine, Huan Tan, Abdul Ghani Mikati, Changbin Shi, Michael Jesselson, Robert Shenkar, Meijing Wu, Ying Cao, Nicholas Hobson, Henrik B.W. Larsson, Gregory A. Christoforidis, Issam A. Awad*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

OBJECTIVE Vascular permeability and iron leakage are central features of cerebral cavernous malformation (CCM) pathogenesis. The authors aimed to correlate prospective clinical behavior of CCM lesions with longitudinal changes in biomarkers of dynamic contrast-enhanced quantitative permeability (DCEQP) and quantitative susceptibility mapping (QSM) assessed by MRI. METHODS Forty-six patients with CCMs underwent 2 or more permeability and/or susceptibility studies in conjunction with baseline and follow-up imaging and clinical surveillance during a mean 12.05 months of follow-up (range 2.4-31.27 months). Based on clinical and imaging features, cases/lesions were classified as stable, unstable, or recovering. Associated and predictive changes in quantitative permeability and susceptibility were investigated. RESULTS Lesional mean permeability and QSM values were not significantly different in stable versus unstable lesions at baseline. Mean lesional permeability in unstable CCMs with lesional bleeding or growth increased significantly (+85.9% change; p = 0.005), while mean permeability in stable and recovering lesions did not significantly change. Mean lesional QSM values significantly increased in unstable lesions (+44.1% change; p = 0.01), decreased slightly with statistical significance in stable lesions (-3.2% change; p = 0.003), and did not significantly change in recovering lesions. Familial cases developing new lesions during the follow-up period showed a higher background brain permeability at baseline (p = 0.001), as well as higher regional permeability (p = 0.003) in the area that would later develop a new lesion as compared with the homologous contralateral brain region. CONCLUSIONS In vivo assessment of vascular permeability and iron deposition on MRI can serve as objective and quantifiable biomarkers of disease activity in CCMs. This may be applied in natural history studies and may help calibrate clinical trials. The 2 techniques are likely applicable in other disorders of vascular integrity and iron leakage such as aging, hemorrhagic microangiopathy, and traumatic brain injury.

Original languageEnglish (US)
Pages (from-to)102-110
Number of pages9
JournalJournal of neurosurgery
Volume127
Issue number1
DOIs
StatePublished - Jul 2017

Keywords

  • Biomarker
  • Cerebral cavernous malformation
  • Dynamic contrast-enhanced quantitative permeability
  • Iron
  • Quantitative susceptibility mapping
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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