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(Stroke. 2003;34:376.)
© 2003 American Heart Association, Inc.

Letters to the Editor

Postmortem MRI as a Useful Tool for Investigation of Cerebral Microbleeds

Department of Neuroradiology, Umberto I Hospital and University of Ancona, Ancona, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with interest the article by Dichgans et al about cerebral microbleeds in CADASIL.¹ The authors demonstrated a high frequency of focal areas of signal loss on gradient-echo MRI, suggesting past microbleeds, in CADASIL patients. They also performed postmortem examinations on the brains of 7 additional CADASIL subjects and found old microbleeds, defined as focal accumulations of hemosiderin-containing macrophages, in 6 of the 7 brains. In their article, the authors regret that none of these had previously been investigated by gradient-echo MRI, thus precluding a correlation study between neuroimaging and postmortem findings.

We felt obliged to suggest that the absence of previous in vivo MRI, however, does not absolutely preclude imaging-pathologic correlation. It has been demonstrated that MRI of excised and formalin-fixed brains, ie, postmortem MRI (pMRI), also called in vitro MRI, is a feasible and reliable method for delineating normal brain anatomy and detecting intracranial lesions.^2–4 It can make correlative studies possible in those cases in which in vivo MRI is lacking, and it also has the advantage of imaging the brain just at the time of pathology, whereas correlation with previous in vivo MRI may be flawed because of changes that occurred between examination and the death of the patient. Changes caused by the fixation process must be considered before extrapolating brain pMRI findings to in vivo MRI, but they have been well described in previous studies.^5–8 According to the literature and to our own experience with this technique, started as far as approximately 10 years ago,^9,10 . . . [Full Text of this Article]

Martin Dichgans, MD

Department of Neurology

Markus Holtmannspötter, MD

Department of Neuroradiology, Klinikum Großhadern, München, Germany

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