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The objective of this pilot study is to detect microbleeds associated with SH using a magnetic resonance imaging (MRI) quantitative susceptibility mapping (QSM) sequence and then evaluate the morphological characteristics of unstable aneurysms with microbleeds.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Twenty CAs in 16 consecutive patients with an initial presentation of headache (HA) leading to a diagnosis of CA were analyzed. Headaches in 4 of the patients (two of whom had 2 aneurysms each) met the typical definition of SH, and the other 12 patients (two of whom also had 2 aneurysms each) all had migraine HA. All patients underwent imaging with the MRI-QSM sequence. Two independent MRI experts who were blinded to the patients\u2019 clinical history performed 3D graphical analysis to evaluate for potential microbleeds associated with these CAs. Computational flow and morphometric analyses were also performed to estimate wall shear and morphological variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In the 4 patients with SH, MRI-QSM results were positive for 4 aneurysms, and hence these aneurysms were considered positive for non-heme ferric iron (microbleeds). The other 16 aneurysms were negative. Among aneurysm shape indices, the undulation index was significantly higher in the QSM-positive group than in the QSM-negative group. In addition, the spatial averaged wall shear magnitude was lower in the aneurysm wall in direct contact with microbleeds.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>MRI-QSM allows for objective detection of microbleeds associated with SH and therefore identification of unstable CAs. CAs with slightly greater undulation indices are associated with positive MRI-QSM results and hence with microbleeds. Studies with larger populations are needed to confirm these preliminary findings.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.2.jns1884","type":"journal-article","created":{"date-parts":[[2018,5,25]],"date-time":"2018-05-25T14:00:02Z","timestamp":1527256802000},"page":"1391-1397","source":"Crossref","is-referenced-by-count":17,"title":["Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping: pilot study"],"prefix":"10.3171","volume":"130","author":[{"given":"Daichi","family":"Nakagawa","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohsuke","family":"Kudo","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olatilewa","family":"Awe","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Zanaty","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunori","family":"Nagahama","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Cushing","sequence":"additional","affiliation":[{"name":"Radiation Oncology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Magnotta","sequence":"additional","affiliation":[{"name":"Radiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minako","family":"Hayakawa","sequence":"additional","affiliation":[{"name":"Radiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Allan","sequence":"additional","affiliation":[{"name":"Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Greenlee","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issam A.","family":"Awad","sequence":"additional","affiliation":[{"name":"Section of Neurosurgery, University of Chicago Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Carroll","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, University of Chicago Medicine and Biological Sciences, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Torner","sequence":"additional","affiliation":[{"name":"Epidemiology, University of Iowa Hospitals and Clinics; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhavan L.","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, Iowa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Hasan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Magn Reson Imaging","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/S0730-725X(98)00155-6","article-title":"MRI evaluation of brain iron in earlier- and later-onset Parkinson\u2019s disease and normal subjects","volume":"17","author":"Bartzokis G","year":"1999","unstructured":"Bartzokis G, Cummings JL, Markham CH, Marmarelis PZ, Treciokas LJ, Tishler TA, : MRI evaluation of brain iron in earlier- and later-onset Parkinson\u2019s disease and normal subjects. 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