Dynamic permeability and quantitative susceptibility: related imaging biomarkers in cerebral cavernous malformations

Stroke. 2014 Feb;45(2):598-601. doi: 10.1161/STROKEAHA.113.003548. Epub 2013 Dec 3.


Background and purpose: Hyperpermeability and iron deposition are 2 central pathophysiological phenomena in human cerebral cavernous malformation (CCM) disease. Here, we used 2 novel MRI techniques to establish a relationship between these phenomena.

Methods: Subjects with CCM disease (4 sporadic and 17 familial) underwent MRI imaging using the dynamic contrast-enhanced quantitative perfusion and quantitative susceptibility mapping techniques that measure hemodynamic factors of vessel leak and iron deposition, respectively, previously demonstrated in CCM disease. Regions of interest encompassing the CCM lesions were analyzed using these techniques.

Results: Susceptibility measured by quantitative susceptibility mapping was positively correlated with permeability of lesions measured using dynamic contrast-enhanced quantitative perfusion (r=0.49; P≤0.0001). The correlation was not affected by factors, including lesion volume, contrast agent, and the use of statin medication. Susceptibility was correlated with lesional blood volume (r=0.4; P=0.0001) but not with lesional blood flow.

Conclusions: The correlation between quantitative susceptibility mapping and dynamic contrast-enhanced quantitative perfusion suggests that the phenomena of permeability and iron deposition are related in CCM; hence, more leaky lesions also manifest a more cumulative iron burden. These techniques might be used as biomarkers to monitor the course of this disease and the effect of therapy.

Keywords: biomarkers; cerebral cavernous malformations; cerebrovascular disorders; hemangioma, cavernous; hemorrhagic stroke; magnetic resonance imaging; vascular permeability.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers
  • Brain Mapping
  • Capillary Permeability / physiology*
  • Child
  • Contrast Media
  • Data Interpretation, Statistical
  • Female
  • Gadolinium
  • Hemangioma, Cavernous, Central Nervous System / pathology*
  • Humans
  • Image Processing, Computer-Assisted
  • Iron / metabolism
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Observer Variation
  • Young Adult


  • Biomarkers
  • Contrast Media
  • Gadolinium
  • Iron