At the neuroconference, Dr. Fleming put up a slide of images from Dad’s MRI. He pointed to several small dark spots.
“When we look on the T2* GRE sequence, we can clearly see microbleeds. But you have to do the correct MRI sequence to detect these bleeds! The GRE or Gradient Refocused Echo takes only an extra 45-55 seconds.”
“I went to the American Society of Neurological Imaging meeting this weekend, and kind of had a bee in my bonnet about this.” He then went through several slides on technical aspects of MRIs. “At every coffee break, I talked with my colleagues about it. Turns out at some centers, every brain gets a GRE, but at many top centers, they don’t routinely do it. When I asked why they don’t, people shrugged. ‘Well, if we find them, what are we going to do,’ they asked. I say, if we don’t find out what’s going on first, we can’t figure out what to do.”
“A sizeable part of the population will have these bleeds,” Dr. Fleming pointed out, bringing up a slide referring to studies showing an estimate 3-12% of various populations have microbleeds. The older you get, the higher the risk, according to this research.
It seemed to me he made a good point about the importance of documenting the microbleeds, even if there’s no treatment yet. Maybe some patients with “probable Alzheimer’s” diagnoses have dementia caused by microbleeds. And maybe there are certain prescription and over-the-counter medicines that should be avoided or used with caution for these patients. I’ll try to find out whether there are any guidelines about this.
We have just submitted a paper to the Journal of Alzheimers' Disease, it has been accepted for publication describing dementia development monitored serially with SWI-MRI, a far more sensitive method for detecting brain microbleeds(BMB) than T2*-GRE. Our group is submitting a TRO1 proposal to the NIH to study the role of BMB on dementia development. Appreciate your work in bringing this matter to public attention
Posted by: Wolff M.Kirsch M.D. | January 27, 2009 at 02:17 PM