{
  "abstract": "Background This study investigates the predictive value of baseline quantitative susceptibility mapping (QSM) metrics for assessing the risk of future symptomatic haemorrhages in patients with brainstem cavernous malformations (CMs).Methods From July 2020 to September 2023, a prospective multicentre cohort of 155 patients with brainstem CMs was enrolled from 12 institutions. We analysed baseline QSM metrics, including lesional mean, median, IQR and maximum susceptibility. Propensity score matching was adjusted for baseline confounders, and Cox regression models assessed haemorrhage risk. Risk stratification was performed based on thresholds determined from planned receiver operating characteristic (ROC) analyses.Results Postmatching cohorts (56 haemorrhage-free vs 30 haemorrhage cases) showed balanced baseline characteristics. Over a mean follow-up of 22.6 months, the baseline QSM metrics, particularly the median susceptibility (QSMmedian) (HR 58.896, 95% CI 8.544 to 405.989, p<0.001; Bonferroni-adjusted p=0.0001, k=4) and IQR of susceptibility (QSMIQR) (HR 29.754, 95% CI 6.101 to 145.119, p<0.001; Bonferroni-adjusted p=0.0001, k=4) were associated with prospective haemorrhage after adjusting for age, gender, lesion volume and prior haemorrhage. QSMmedian (area under curve (AUC)=0.759) and QSMIQR (AUC=0.740) demonstrated modest predictive performance. Risk stratification based on QSMmedian and QSMIQR demonstrated 2-year haemorrhage-free survival rates of 83.3%, 62.8% and 35.7% for the low-risk, intermediate-risk and high-risk groups, respectively. High-risk patients showed a 7.7-fold greater risk of haemorrhage compared with the low-risk group.Conclusions This study explored the predictive value of QSM metrics for future symptomatic haemorrhage, suggesting that QSM may serve as a complementary imaging biomarker to existing prognostic models. Further validation in larger, independent cohorts is warranted.",
  "authors": [
    {
      "affiliations": [
        "Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Si-Hui Wang"
    },
    {
      "affiliations": [
        "Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China"
      ],
      "name": "Hong-Wei Li"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China"
      ],
      "name": "Jian-Cong Weng"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China",
        "Graduate School of Peking Union Medical College, Beijing, China"
      ],
      "name": "Yan-Bing Yu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China"
      ],
      "name": "Gui-Jun Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Bo-Han Yao"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China"
      ],
      "name": "Pan-Pan Liu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, China"
      ],
      "name": "Lu Kong"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The First People’s Hospital of Lianyungang, Lianyungang, China"
      ],
      "name": "Hui Zhou"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Hao-Yu Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The Second People’s Hospital of Shenzhen, Shenzhen, China"
      ],
      "name": "Xiao-Jun Zeng"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China"
      ],
      "name": "Ze-Yu Wu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Electric Power Hospital, Beijing, China"
      ],
      "name": "Cong Ren"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Peking University BinHai Hospital, Tianjin, China"
      ],
      "name": "Wei Wang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Puhua Hospital, Beijing, China"
      ],
      "name": "Hong-Jun Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Jun-Peng Ma"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Xiao-Ying Xu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Lai-Rong Song"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Jun-Ting Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Zhen Wu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Liang Wang"
    },
    {
      "affiliations": [
        "Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Sheng-Jun Sun"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing, China"
      ],
      "name": "Da Li"
    }
  ],
  "title": "QSM predicts haemorrhage risk in brainstem cavernous malformations: a multicentre prospective study",
  "uid": "e54cb163-7060-5f2b-a3f6-ade2ccef8616"
}