{"doi":"10.3171/2020.1.jns193479","title":"Subclinical imaging changes in cerebral cavernous angiomas during prospective surveillance","abstract":"OBJECTIVE: The purpose of this study was to systematically assess asymptomatic changes (ACs), including subclinical hemorrhage, growth, or new lesion formation (NLF) during longitudinal follow-up of cerebral cavernous angiomas (CAs), and to correlate these with symptomatic hemorrhage (SH) during the same period and with clinical features of the disease. METHODS: One hundred ninety-two patients were included in this study, among 327 consecutive patients with CA, prospectively identified between September 2009 and February 2019. Included patients had undergone clinical and MRI follow-up, in conjunction with institutional review board-approved biomarker studies, and harbored ≥ 1 CA with a maximum diameter of ≥ 5 mm on T2-weighted MRI. Rates of AC and SH per lesion-year and patient-year were assessed using prospectively articulated criteria. In multifocal/familial cases, rates of NLF were also assessed. RESULTS: There were no differences in demographic or disease features among cases included or excluded in the study cohort, except for a higher proportion of included patients with CCM3 mutation. Follow-up was 411 patient-years (2503 lesion-years). The rate of AC was higher than the rate of SH (12.9% vs 7.5% per patient-year, and 2.1% vs 1.2% per lesion-year, both p = 0.02). Patients presenting with a prior history of SH had a higher rate of AC than those with other forms of presentation (19.7% and 8.2% per patient-year, respectively; p = 0.003). A higher rate of NLF on T2-weighted MRI (p = 0.03) was observed in patients with prior SH. Three of 6 solitary/sporadic and 2 of 28 multifocal/familial patients underwent resection of the lesion after AC. CONCLUSIONS: Rates of AC are greater than SH during prospective follow-up of CAs, and greater in cases with prior SH. AC may be a more sensitive biomarker of lesional activity, and a more efficient surrogate outcome in clinical trials than SH. Patients experiencing an AC are more likely to undergo a surgical intervention when CAs are solitary/sporadic than when they are multifocal/familial.","journal":"Journal of neurosurgery","year":2020,"id":103859,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":24,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8029,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":505140,"name":"Hussein A. Zeineddine","orcid":"0000-0001-6144-8392","position":1,"is_corresponding":false},{"id":313680,"name":"Sean P. Polster","orcid":"0000-0002-3229-5021","position":2,"is_corresponding":false},{"id":313686,"name":"Romuald Girard","orcid":"0000-0002-5893-9315","position":3,"is_corresponding":false},{"id":313682,"name":"Séan Lyne","orcid":"0000-0002-9270-7518","position":4,"is_corresponding":false},{"id":337376,"name":"Janne Koskimäki","orcid":"0000-0002-2311-6327","position":5,"is_corresponding":false},{"id":337378,"name":"Sharbel Romanos","orcid":"0000-0002-0719-6355","position":6,"is_corresponding":false},{"id":429034,"name":"Abhinav Srinath","orcid":"0000-0001-7336-7231","position":7,"is_corresponding":false},{"id":351075,"name":"Dongdong Zhang","orcid":"0000-0002-7111-8378","position":8,"is_corresponding":false},{"id":313683,"name":"Ying Cao","orcid":"0000-0001-9846-0176","position":9,"is_corresponding":false},{"id":313685,"name":"Agnieszka Stadnik","orcid":"0000-0002-2038-6487","position":10,"is_corresponding":false},{"id":491240,"name":"Kristina Piedad","orcid":null,"position":11,"is_corresponding":false},{"id":337379,"name":"Robert Shenkar","orcid":"0000-0002-1300-6845","position":12,"is_corresponding":false},{"id":313407,"name":"Issam A. Awad","orcid":"0000-0003-1510-602X","position":13,"is_corresponding":false},{"id":313681,"name":"Julián Carrión‐Penagos","orcid":"0000-0002-5773-0966","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-18T22:42:48.999009Z","pmid":"32244216","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}