Radiologic-Histopathologic Correlation of Cerebral Microbleeds Using Pre-Mortem and Post-Mortem MRI

PLoS One. 2016 Dec 9;11(12):e0167743. doi: 10.1371/journal.pone.0167743. eCollection 2016.


Introduction: Cerebral microbleeds (CMB), also known as cerebral microhemorrhages, are small areas of susceptibility on brain magnetic resonance imaging (MRI), that are increasingly detected due to the higher availability of high-field MRI systems and dedicated pulse sequences. The prevalence of CMBs increases in cases with cognitive decline. The current investigation assessed the poorly investigated radiologic-histopathologic correlation of CMBs on MRI.

Methods: The local ethical committee approved the current investigation. We retrospectively assessed a consecutive series of 1303 autopsy cases hospitalized in Geneva University Hospitals between 2000-2014. Of 112 cases with pre-mortem T2* sequences, we included 25 cases (mean age 77.3 ± 9.6, 9 females) with at least one CMB. We compared pre-mortem CMBs with targeted histopathology and post-mortem MRI.

Results: 25 cases had 31 CMB lesions detected by pre-mortem MRI. 25 additional CMB were detected on histopathology. 4 CMBs on pre-mortem MRI were false positives, resulting in a total of 52 CMBs. 27 CMBs on pre-mortem MRI were confirmed on histopathology, corresponding to a sensitivity or true positive rate of 51.9% (95% CI 37.6-66.0%). The false negative rate of pre-mortem MRI was 48.1% (95% CI 34.0-62.4%). Post-mortem MRI showed only 3 cases with additional CMBs. Overall, pre-mortem MRI significantly underestimated CMBs (p = 0.0001).

Conclusions: Routine clinical brain MRI underestimates the prevalence of CMBs by approximately 50%, and 12% of radiologic pre-mortem MRI CMBs were false positives. Post-mortem MRI confirmed that this discordance is not explained by microbleeds occurring after the pre-mortem MRI.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain / blood supply
  • Brain / diagnostic imaging
  • Brain / pathology*
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / pathology*
  • Diagnosis
  • Female
  • Histological Techniques
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Retrospective Studies

Grant support

This work is supported in part by Swiss National Foundation Grant SNF 320030_159990/1 and an unrestricted grant from the Association Suisse pour la Recherche Alzheimer, Geneva.