Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Quantification of Iron Deposition in the Brain of Hypertensive Patients using 3D-enhanced Susceptibility-weighted Angiography (ESWAN)

Author(s): Jiehua Yang*, Zhongxian Yang, Huanze Wu and Wei Chen

Volume 20, 2024

Published on: 07 August, 2023

Article ID: e270623218305 Pages: 12

DOI: 10.2174/1573405620666230627112146

open_access

Open Access Journals Promotions 2
conference banner
Abstract

Background: Cerebral microbleeds (CMBs) are commonly present in patients with hypertension, producing iron-containing metabolites. A small amount of regional iron deposition is hardly discernible on conventional magnetic resonance imaging (MRI). Three-dimensional enhanced susceptibilityweighted angiography (ESWAN) provides tissue images with high spatial resolution and signal-noise ratio, and has been widely used to measure brain iron deposition in neurodegenerative diseases and intracranial hemorrhage.

Objective: The study aimed to demonstrate iron deposition in the brain of hypertensive patients using ESWAN.

Methods: Twenty-seven hypertension patients, with or without CMBs, and 16 matched healthy controls (HCs) were enrolled. From the post-processed ESWAN images, phase and magnitude values of the regions of interest (ROIs) were calculated. Two-sample t-test and one-way variance analysis were applied to compare groups. The relationship between ESWAN parameters and clinical variables was assessed using Pearson’s correlation coefficient.

Results: Compared to HCs, the phase value of the hippocampus, head of caudate nucleus (HCN), and substantia nigra (SN) was decreased in hypertension with the CMBs subgroup, while that of HCN and SN was decreased in hypertension without CMBs subgroup. Similarly, the magnitude value of the hippocampus, HCN, thalamus red nucleus, and SN was significantly lower in the hypertension group than HCs. In addition, the phase and magnitude values showed a correlation with clinical variables, including disease duration and blood pressure.

Conclusion: Deep grey matter nuclei displayed greater iron content in hypertension patients. Iron deposition may precede the appearance of CMBs on MRI, serving as a potential marker of microvascular damage.

Keywords: Iron deposition, Hypertension, Cerebral microbleeds, 3D-enhanced susceptibility-weighted angiography, Susceptibility-weighted imaging, Phase value, Magnitude value.

[1]
Pantoni L. Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9(7): 689-701.
[http://dx.doi.org/10.1016/S1474-4422(10)70104-6] [PMID: 20610345]
[2]
Liang C, Wang J, Feng M, Zhang N, Guo L. White matter changes, duration of hypertension, and age are associated with cerebral microbleeds in patients with different stages of hypertension. Quant Imaging Med Surg 2022; 12(1): 119-30.
[http://dx.doi.org/10.21037/qims-21-28] [PMID: 34993065]
[3]
Hou Y, Li Y, Yang S, Qin W, Yang L, Hu W. Gait impairment and upper extremity disturbance are associated with total magnetic resonance imaging cerebral small vessel disease burden. Front Aging Neurosci 2021; 13: 640844.
[http://dx.doi.org/10.3389/fnagi.2021.640844] [PMID: 34054501]
[4]
You P, Li X, Wang Z, Wang H, Dong B, Li Q. Characterization of brain iron deposition pattern and its association with genetic risk factor in alzheimer’s disease using susceptibility-weighted imaging. Front Hum Neurosci 2021; 15: 654381.
[http://dx.doi.org/10.3389/fnhum.2021.654381] [PMID: 34163341]
[5]
Du S, Sah SK, Zeng C, et al. Iron deposition in the gray matter in patients with relapse-remitting multiple sclerosis: A longitudinal study using three-dimensional (3D)-enhanced T2*-weighted angiography (ESWAN). Eur J Radiol 2015; 84(7): 1325-32.
[http://dx.doi.org/10.1016/j.ejrad.2015.04.013] [PMID: 25959392]
[6]
Haacke EM, Mittal S, Wu Z, Neelavalli J, Cheng YCN. Susceptibility-weighted imaging: Technical aspects and clinical applications, part 1. AJNR Am J Neuroradiol 2009; 30(1): 19-30.
[http://dx.doi.org/10.3174/ajnr.A1400] [PMID: 19039041]
[7]
Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility-weighted imaging: Technical aspects and clinical applications, part 2. AJNR Am J Neuroradiol 2009; 30(2): 232-52.
[http://dx.doi.org/10.3174/ajnr.A1461] [PMID: 19131406]
[8]
Thomas GEC, Leyland LA, Schrag AE, Lees AJ, Acosta-Cabronero J, Weil RS. Brain iron deposition is linked with cognitive severity in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2020; 91(4): 418-25.
[http://dx.doi.org/10.1136/jnnp-2019-322042] [PMID: 32079673]
[9]
Zeng C, Chen X, Li Y, et al. Cerebral vein changes in relapsing-remitting multiple sclerosis demonstrated by three-dimensional enhanced T2*-weighted angiography at 3.0 T. Eur Radiol 2013; 23(3): 869-78.
[http://dx.doi.org/10.1007/s00330-012-2637-5] [PMID: 22968782]
[10]
Gang Q, Zhang J, Hao P, Xu Y. Detection of hypoxic-ischemic brain injury with 3D-enhanced T2* weighted angiography (ESWAN) imaging. Eur J Radiol 2013; 82(11): 1973-80.
[http://dx.doi.org/10.1016/j.ejrad.2013.05.023] [PMID: 23777745]
[11]
Chen X, Zeng C, Luo T, et al. Iron deposition of the deep grey matter in patients with multiple sclerosis and neuromyelitis optica: A control quantitative study by 3D-enhanced susceptibility-weighted angiography (ESWAN). Eur J Radiol 2012; 81(4): e633-9.
[http://dx.doi.org/10.1016/j.ejrad.2012.01.003] [PMID: 22280874]
[12]
Zeng C, Du S, Han Y, et al. Optic radiations are thinner and show signs of iron deposition in patients with long-standing remitting-relapsing multiple sclerosis: An enhanced T2*-weighted angiography imaging study. Eur Radiol 2018; 28(10): 4447-54.
[http://dx.doi.org/10.1007/s00330-018-5461-8] [PMID: 29713769]
[13]
Li Y, Song QW, Sun MY, et al. Use of enhanced T2 star-weighted angiography (ESWAN) and R2* values to distinguish ovarian cysts due to endometriosis from other causes. Abdom Imaging 2015; 40(6): 1733-41.
[http://dx.doi.org/10.1007/s00261-014-0314-7] [PMID: 25504223]
[14]
Yang J, Li X, Yang R, et al. Susceptibility-weighted imaging manifestations in the brain of Wilson’s Disease Patients. PLoS One 2015; 10(4): e0125100.
[http://dx.doi.org/10.1371/journal.pone.0125100] [PMID: 25915414]
[15]
Tong KA, Ashwal S, Obenaus A, Nickerson JP, Kido D, Haacke EM. Susceptibility-weighted MR imaging: A review of clinical applications in children. AJNR Am J Neuroradiol 2008; 29(1): 9-17.
[http://dx.doi.org/10.3174/ajnr.A0786] [PMID: 17925363]
[16]
Sood S, Gupta R, Modi J, Sharma J. Susceptibility Weighted Imaging: Physics and Clinical applications in Neuroimaging at 3 Tesla. European Congress of Radiology. Vienna, Austria. 2014; pp. 9-17.
[17]
Guo LF, Geng J, Qiu MH, Mao CH, Liu C, Cui L. Quantification of phase values of cerebral microbleeds in hypertensive patients using ESWAN MRI. Clin Neuroradiol 2013; 23(3): 197-205.
[http://dx.doi.org/10.1007/s00062-012-0196-4] [PMID: 23334227]
[18]
Valdés Hernández M, Allerhand M, Glatz A, et al. Do white matter hyperintensities mediate the association between brain iron deposition and cognitive abilities in older people? Eur J Neurol 2016; 23(7): 1202-9.
[http://dx.doi.org/10.1111/ene.13006] [PMID: 27094820]
[19]
Guo LF, Wang G, Zhu XY, Liu C, Cui L. Comparison of ESWAN, SWI-SPGR, and 2D T2*-weighted GRE sequence for depicting cerebral microbleeds. Clin Neuroradiol 2013; 23(2): 121-7.
[http://dx.doi.org/10.1007/s00062-012-0185-7] [PMID: 23212660]
[20]
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. J Psychiatr Res 1975; 12(3): 189-98.
[http://dx.doi.org/10.1016/0022-3956(75)90026-6] [PMID: 1202204]
[21]
Haacke EM, Ayaz M, Khan A, et al. Establishing a baseline phase behavior in magnetic resonance imaging to determine normal vs.abnormal iron content in the brain. J Magn Reson Imaging 2007; 26(2): 256-64.
[http://dx.doi.org/10.1002/jmri.22987] [PMID: 17654738]
[22]
Chen L, Zhang J, Wang Q-X, et al. Enhanced susceptibility-weighted angiography (ESWAN) of cerebral arteries and veins at 1.5 Tesla. Br J Radiol 2014; 87(1039): 20130486.
[http://dx.doi.org/10.1259/bjr.20130486] [PMID: 24786315]
[23]
Jia Z, Mohammed W, Qiu Y, Hong X, Shi H. Hypertension increases the risk of cerebral microbleed in the territory of posterior cerebral artery: A study of the association of microbleeds categorized on a basis of vascular territories and cardiovascular risk factors. J Stroke Cerebrovasc Dis 2014; 23(1): e5-e11.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.12.016] [PMID: 23434162]
[24]
Piloni NE, Fermandez V, Videla LA, Puntarulo S. Acute iron overload and oxidative stress in brain. Toxicology 2013; 314(1): 174-82.
[http://dx.doi.org/10.1016/j.tox.2013.09.015] [PMID: 24120471]
[25]
Haacke EM, Garbern J, Miao Y, Habib C, Liu M. Iron stores and cerebral veins in MS studied by susceptibility weighted imaging. Int Angiol 2010; 29(2): 149-57.
[PMID: 20351671]
[26]
Rodrigue KM, Haacke EM, Raz N. Differential effects of age and history of hypertension on regional brain volumes and iron. Neuroimage 2011; 54(2): 750-9.
[http://dx.doi.org/10.1016/j.neuroimage.2010.09.068] [PMID: 20923707]
[27]
Wang J, Tang X, Xia M, et al. Iron chelation suppresses secondary bleeding after intracerebral hemorrhage in angiotensin II-infused mice. CNS Neurosci Ther 2021; 27(11): 1327-38.
[http://dx.doi.org/10.1111/cns.13706] [PMID: 34346561]
[28]
Li J, Zhang Q, Che Y, Zhang N, Guo L. Iron deposition characteristics of deep gray matter in elderly individuals in the community revealed by quantitative susceptibility mapping and multiple factor analysis. Front Aging Neurosci 2021; 13: 611891.
[http://dx.doi.org/10.3389/fnagi.2021.611891] [PMID: 33935681]
[29]
Haller S, Bartsch A, Nguyen D, et al. Cerebral microhemorrhage and iron deposition in mild cognitive impairment: Susceptibility-weighted MR imaging assessment. Radiology 2010; 257(3): 764-73.
[http://dx.doi.org/10.1148/radiol.10100612] [PMID: 20923870]

© 2024 Bentham Science Publishers | Privacy Policy