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ORIGINAL ARTICLE
Year : 2013  |  Volume : 61  |  Issue : 4  |  Page : 389-395

Susceptibility-weighted imaging: The value in cerebral astrocytomas grading


Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China

Date of Submission04-Jan-2013
Date of Decision28-Jan-2013
Date of Acceptance24-Jul-2013
Date of Web Publication4-Sep-2013

Correspondence Address:
Yan Tan
Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.117617

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 » Abstract 

Objective: To investigate the value of susceptibility weighted imaging (SWI) in evaluating the histopathologic grade of cerebral astrocytomas and compare the relative value of SWI and conventional magnetic resonance imaging (MRI) sequences. Materials and Methods: This is an analysis of 26 untreated patients with pathologically confirmed astrocytomas. The tumors were classified as low grade (grade I-II: 12 cases) or high grade (grade III-IV: 14 cases). Imaging was performed with a 3.0 T MRI scanner. Conventional sequences [T1-weighted imaging (T1WI), contrast enhanced T1WI (CE-T1WI), T2-weighted imaging (T2WI), and T2 FLuid Attenuated Inversion Recovery (T2FLAIR)] and SWI sequence (including CE-SWI) were done. The number of small vessels and the amount of blood products in the tumors were determined for each sequence. Differences between the two groups were analyzed statistically. Results: SWI was more sensitive than conventional sequences (T1WI, CE-T1WI, T2WI, and T2FLAIR) in visualizing small vessels and microhemorrhages in cerebral astrocytomas (P < 0.01). CE-SWI was better than CE-T1WI sequences for visualizing tumor small vessels and microhemorrhages. SWI visualized greater numbers of small vessels and areas of microhemorrhages in high-grade tumors than in low-grade tumors (P < 0.01). This was especially true after contrast administration (P < 0.01). Conclusion: SWI plays an important role in astrocytoma grading, especially for enhanced astrocytomas after contrast injection. CE-SWI was better than CE-T1WI in visualizing tumor architecture.


Keywords: Astrocytomas, grade, susceptibility weighted imaging


How to cite this article:
Zhang H, Tan Y, Wang XC, Qing JB, Wang L, Wu XF, Zhang L, Liu Qw. Susceptibility-weighted imaging: The value in cerebral astrocytomas grading. Neurol India 2013;61:389-95

How to cite this URL:
Zhang H, Tan Y, Wang XC, Qing JB, Wang L, Wu XF, Zhang L, Liu Qw. Susceptibility-weighted imaging: The value in cerebral astrocytomas grading. Neurol India [serial online] 2013 [cited 2020 May 24];61:389-95. Available from: http://www.neurologyindia.com/text.asp?2013/61/4/389/117617



 » Introduction Top


Susceptibility weighted imaging (SWI) is a novel imaging tool to detects small veins and extravascular blood products. [1]

Blood vessel proliferation and hemorrhage of tumors play an important role in the grading of astrocytomas. The amount of ferritin and transferrin receptors has been shown to correlate with tumor grade. [2],[3] The purpose of our study was to evaluate the value of SWI in grading cerebral astrocytomas and compare the relative value of SWI and conventional sequences.


 » Materials and Methods Top


Twenty-six patients (14 males and 12 females; mean age: 45.3 years; range: 20-58 years) with untreated astrocytomas confirmed by pathology were identified between January 2010 and September 2012. Tumor grading was as proposed by the inclusion criteria of the World Health Organization Classification of Tumors of the Nervous System, 2000. Exclusion criteria were cystic astrocytomas and recurrent astrocytomas. The patients were divided into two groups: low-grade astrocytomas (grade I-II: 12 cases) and high-grade astrocytomas (grade III-IV: 14 cases). The institutional review board approved this retrospective study and informed consent was waived.

MR imaging techniques

All examinations were performed with a Signa HDX 3.0 T MRI scanner using an eight-channel array coil. The scanning sequences included conventional MR sequences [T1-weighted imaging (T1WI), contrast enhanced T1WI (CE-T1WI), T2-weighted imaging (T2WI), and T2 FLuid Attenuated Inversion Recovery (T2FLAIR)] and SWI [phase map-SWI, intensity map-SWI and contrast enhanced SWI (CE-SWI) sequences]. The parameters used for conventional MR sequences were repetition time (TR) 195 ms and echo time (TE) 4.76 ms for gradient-echo (GRE) T1-weighted imaging, TR 4000 ms and TE 98 ms for fast spin-echo T2-weighted imaging, and TR 8000ms, TE 95 ms, inversion time (TI) 2371.8 ms for FLAIR T2-weighted images, and enhanced spin-echo for FLAIR T1-weighted images. Slice thickness and slice interval was 5.0/1.5 mm. Field of view (FOV) was 240 × 240 mm; 0.1 mmol/kg of gadolinium chelate contrast was injected for contrast enhanced imaging.

The parameters used for pre and postcontrast SWI were TR 49 ms, TE 40 ms, flip angle (FA) 15°, slice thickness: 2 mm, matrix size: 256 × 202, and FOV: 230 × 201 mm. Minimum intensity projection (MinIP) of the pre-enhanced SWI and maximum intensity projection (MaxIP) of CE-SWI were reconstructed using an ADW 4.3 workstation.

MR image analysis

Imaging data from the 26 patients was measured independently by two radiologists blinded to the pathological results. Each radiologist measured the maximum cross-sectional bleeding extent of the mass image three times, and the total mean ± standard deviation was calculated. The maximum cross-sectional area of hemorrhage and the number of small vessels on SWI sequences and conventional MRI sequences were compared. Siemens' Leonard Workstation area measurement software was used to calculate the maximum cross-sectional area of bleeding. Signals characteristics, tumor small vessel distribution (sparse, dense), and tumor bleeding (maximum cross-sectional area of bleeding) were evaluated in low- and high-grade astrocytomas using SWI. Tumor hemorrhage was characterized by a patchy, flaky low-intensity signal, irregular size, and uneven distribution [Figure 1]. Small tumor vessels had an elongated, curved tubular, or cylindrical shape with a low signal and a clear boundary that could be followed on contiguous slices [Figure 1].
Figure 1: Small vessels and area of hemorrhage in an astrocytoma visualized with susceptibility weighted imaging. The tumor hemorrhage was seen as a nonuniform low‑intensity signal associated with an irregular lesion (arrowheads). Tumor small vessels were low‑signal and with clear boundary that could be followed on contiguous slices (long arrow)

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Statistical analysis

SPSS16.0. statistical analysis software was used. The difference between conventional MR sequences (T1WI, T2WI, T2FLAIR, CE-T1WI) and SWI sequences (phase map-SWI, CE-SWI, intensity map-SWI) in the detection of small vessels and area of hemorrhage were analyzed using one-way analysis of variance (ANOVA). A Wilcoxon test was used to analyze the difference in the number of small vessels and hemorrhage area visualized by SWI between low- and high-grade tumors; P < 0.05 was considered to be statistically significant.


 » Results Top


Number of small vessels and microhemorrhage visualized with SWI and conventional MR sequences

The results of conventional MR sequences and SWI sequences are shown in [Table 1]. Interclass analysis showed that T1WI and CE-T1WI did not show small vessels well [Figure 2], [Figure 3], [Figure 4] and [Figure 5], a and b] and that T2WI and T2FLAIR had better results [Figure 2], [Figure 3], [Figure 4] and [Figure 5], c and d]; however, SWI and CE-SWI were superior [Figure 2], [Figure 3], [Figure 4] and [Figure 5], e-g]. CE-T1WI did not show microhemorrhage very well [Figure 2], [Figure 3], [Figure 4] and [Figure 5], b], T1WI, T2WI, and T2FLAIR were better [Figure 2], [Figure 3], [Figure 4] and [Figure 5], a, c and d], but SWI and CE-SWI were the best [Figure 2], [Figure 3], [Figure 4] and [Figure 5], e-g]. There were statistically significant differences (P < 0.05) among these three MRI sequence groups. CE-SWI was better than CE-T1WI (P < 0.01) in visualizing tumor small vessels, microhemorrhage, and solid portions of the tumor [Figure 3], [Figure 4] and [Figure 5], b and f].
Figure 2: A 43‑year‑old male with grade II astrocytoma. The lesion was located in the right frontal lobe. There were no small vessels or microhemorrhage seen with conventional sequences [T1‑weighted imaging (T1WI; a), contrast enhanced T1WI (CE‑T1WI; b), T2‑weighted imaging (T2WI; c), and T2 FLuid Attenuated Inversion Recovery (T2‑FLAIR; d)] and susceptibility weighted imaging (SWI) sequence [phase map‑SWI (e), CE‑SWI (f), intensity map‑SWI (g)]; hematoxylin and eosin (H and E) (h) staining demonstrated no small vessels or microhemorrhage in the tumor

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Figure 3: A 53‑year‑old male with grade II astrocytoma. The lesion was located in the left frontal lobe. There were no small vessels or microhemorrhage seen with conventional sequences [T1‑weighted imaging (T1WI; a), contrast enhanced T1WI (CE‑T1WI; b), T2‑weighted imaging (T2WI; c), and T2 FLuid Attenuated Inversion Recovery (T2FLAIR; d)]. A few small vessels with low‑signal intensity were seen using susceptibility weighted imaging (SWI) sequences [phase map‑SWI (e), CE‑SWI (f), intensity map‑SWI (g)]; hematoxylin and eosin (H and E) staining (h) showed a few tumor vessels between the tumor cells (black arrow)

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Figure 4: A 57‑year‑old male with grade III astrocytoma. The lesion was located in the right frontal lobe. A few small vessels and no hemorrhage were seen in T1‑weighted imaging (T1WI; a), contrast enhanced T1WI (CE‑T1WI; b), T2‑weighted imaging (T2WI; c), and T2 FLuid Attenuated Inversion Recovery (T2FLAIR; d). Susceptibility weighted imaging (SWI) sequences (e and g) visualized many small vessels (black arrow) and hemorrhage (white arrow). The lesion was hypointense with a sharp border. CE‑SWI (f) demonstrated a change to hyperintensity because of the small vessels (black arrow). Hemorrhage remained hypointense with an irregular shape (white arrow). Hematoxylin and eosin (H and E) staining (h) showed many hemorrhage areas between the tumor cells (black arrow)

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Figure 5: A 44‑year‑old female with grade IV astrocytoma. The lesion was in the left frontal lobe. A few small vessels and many areas of hemorrhage were seen in T1‑weighted imaging (T1WI; a) and contrast enhanced T1WI (CE‑T1WI; b). More small vessels and hemorrhage in T2‑weighted imaging (T2WI; c) and T2 FLuid Attenuated Inversion Recovery (T2FLAIR; d). Susceptibility weighted imaging (SWI) sequences (e and g) visualized many small vessels (long white arrow) and hemorrhage (short white arrow). Areas of hemorrhage had a sharp border. CE‑SWI (f) visualized solid portions (black arrow), small vessels (long white arrow), and hemorrhage (short white arrow). Hematoxylin and eosin (H and E) staining (h) showed many hemorrhage areas between the tumor cells (black arrow)

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Table 1: The number of small vessels and microhemorrhage areas shown in SWI and conventional MR sequences

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Visualization of small vessels and microhemorrhage by SWI sequences in the two tumor grades

The number of small vessels and microhemorrhage visualized with SWI sequences was broken down by tumor grade [Table 2]. There was a significant difference in the two groups in the number of small vessels and area of microhemorrhage (P < 0.01). More small vessels and microhemorrhage was seen in the high-grade group [Figure 4], Figure5, e-g] than in the low-grade group [Figure 2], Figure3, e-g].
Table 2: The number of small vessels and microhemorrhage areas shown in the two groups in SWI sequence

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Visualization of small vessel and microhemorrhage by enhanced SWI sequences in the two tumor grades

The number of small vessels and area of microhemorrhage visualized in astrocytomas with enhanced SWI is shown in [Table 3]. Thirteen high-grade and six low-grade astrocytomas were imaged using enhanced SWI. There was a significant difference in the number of small vessels and microhemorrhage area between the two tumor grades (P < 0.01). The number of small vessels and area of microhemorrhage was greater in grade III-IV astrocytomas [Figure 4], [Figure 5], e-g] than in grade I-II astrocytomas [Figure 3], e-g].
Table 3: The number of small vessels and microhemorrhage areas shown in enhanced astrocytomas in SWI sequence

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Density of tumor blood vessels by tumor grade

The distribution features of tumor blood vessels stratified by tumor grade are shown in [Table 4]. Using the approach of Kim et al., [4] blood vessel density was characterized. Less than 10 tumor blood vessels was considered sparse, and greater than or equal to 10 was considered dense. More cases (12 of 14) that were characterized as 'dense' by SWI were seen in the high-grade group [Figure 4], [Figure 5], e-g]. Conversely, more low-grade cases were characterized as having 'sparse' vessel density by SWI (9 of 12) [Figure 2], [Figure 3], e-g].
Table 4: The distribution features of tumor blood vessels shown in the two groups in SWI sequence

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 » Discussion Top


SWI is a relatively new MRI sequence that demonstrates magnetic susceptibility differences in various tissues. It is very sensitive in detecting blood products, calcium, iron, and small veins. [5],[6],[7] Zhang et al. [8] reported that SWI was more sensitive than common MRI sequences in visualizing tumor blood products and areas of microhemorrhage. Li et al. [2] found that SWI was superior to conventional imaging techniques in visualizing small vessels and microhemorrhage in brain astrocytoma. We also found that SWI sequences (including CE-SWI) were better than conventional imaging techniques (T1WI, CE-T1WI, T2WI, T2FLAIR) in demonstrating small vessels and microhemorrhage.

Some authors have proposed that SWI should be performed with enhancement, because the contrast agent could shorten T1 relaxation time of blood and scanning time. [9],[10] Mittal et al. [11] demonstrated that hemorrhage could be easily distinguished from veins if high-resolution (HR)-SWI was performed both before and after contrast enhancement. Tumor blood vessels changed their signal intensity with the contrast agent, whereas the signal of the hemorrhage did not. CE-SWI has been reported to visualize tumor details better than CE-T1WI. [9],[10] Using CE-T1WI, brain tumors demonstrated a diffuse enhancement without visualization of the structural characteristics within the tumor microvasculature. We also found that CE-SWI was better than CE-T1WI in visualizing tumor architecture. CE-SWI visualized the enhanced solid components of the tumors, tumor vessels, and microhemorrhage. This imaging approach could facilitate the performance of biopsies.

MRI features are related to the histological grade of the astrocytoma. Many imaging characteristics have been suggested to predict glioma grade. These include heterogeneity, mass effect, cyst formation, necrosis, contrast enhancement, and cerebral blood volume. [12] Some astrocytomas have characteristic imaging features that are correlated with tumor grade, whereas others do not. High-grade astrocytomas are usually vascular and contain areas of hemorrhage. Hemorrhage has a relatively large amount of deoxyhemoglobin, which has a characteristic loss of signal intensity. [9],[13] Barth et al. [14] reported that imaging features and tumor microvascularity correlated with tumor grade. It has been reported [9],[11] that the detection of the intratumoral susceptibility signal intensity (ITSS) in higher grade gliomas not only reflects tumor vascularity but also indicates macro and microhemorrhage in higher grade gliomas. We found that the SWI sequence detected, on an average, 35.50±3.97 small vessels in high-grade astrocytomas and 6.40±4.25 in low-grade astrocytomas (P < 0.05). High-grade astrocytomas had a mean area of 450.0±4.06 mm 2 of microhemorrhage and low-grade astrocytomas, 18.3±2.05 mm 2 (P < 0.05). The SWI sequence detected more small vessels and microhemorrhage, which correlated with vascularity in astrocytomas. The SWI sequence was thus valuable in the grading of tumors. This novel sequence may be a promising tool for the noninvasive grading of astrocytomas.

In some patients, the accuracy of common MRI in assessing astrocytoma grade is somewhat limited. Although commonly associated with high-grade tumors, contrast enhancement on postgadolinium T1-weighted images is quite variable. We identified six patients with low-grade astrocytomas that enhanced with conventional MR sequences and it was difficult to assign them a tumor grade based on MR imaging alone. CE-SWI visualized more of the small vessels and a larger area of microhemorrhage in grade III-IV astrocytomas than grade II astrocytomas. We found enhanced SWI to be a useful tool in the grading of astrocytomas. To the best of our knowledge, our approach to quantify both the vessel density and microhemorrhage area has not been previously reported in the literature.

The accurate grading of astrocytomas has important therapeutic and prognostic implications, because patients with high-grade astrocytomas must receive either radiochemotherapy or radiation therapy. Low-grade astrocytomas are treated with surgical resection for curative intent. Radiochemotherapy is only used in patients with low-grade astrocytomas that were incompletely resected or in patients who were less than 40 years of age after resection. [2],[15],[16] SWI can improve the sensitivity of MRI in the preoperative and postoperative diagnosis of astrocytoma.

With the advent of 3T MRI and parallel imaging techniques, the acquisition time of SWI is practical for a typical clinic workflow. [5] SWI sequence imaging with spatial resolution can be acquired in less than four minutes, as shown in our study. We found that SWI was an extremely useful adjunct to current MRI sequences in the grading of astrocytomas. Based on our results, our routine brain MRI sequences now include nonenhanced SWI. SWI appears to accurately grade cerebral astrocytomas, especially for enhanced astrocytomas after contrast injection. CE-SWI was significantly better than CE-T1WI in visualizing tumor and vascular architecture.

 
 » References Top

1.Haddar D, Haacke E, Sehgal V, Delproposto Z, Salamon G, Seror O, et al. Susceptibility weighted imaging. Theory and applications. J Radiol 2004;85:1901-8.  Back to cited text no. 1
[PUBMED]    
2.Li C, Ai B, Li Y, Qi H, Wu L. Susceptibility-weighted imaging in grading brain astrocytomas. Eur J Radiol 2010;75: e81-5.  Back to cited text no. 2
[PUBMED]    
3.Al Sayyari A, Buckley R, McHenery C, Pannek K, Coulthard A, Rose S. Distinguishing recurrent primary brain tumor from radiation injury: A preliminary study using a susceptibility-weighted MR imaging-guided apparent diffusion coefficient analysis strategy. AJNR Am J Neuroradiol 2010;31:1049-54.  Back to cited text no. 3
[PUBMED]    
4.Kim HS, Jahng GH, Ryu CW, Kim SY. Added value and diagnostic performance of intratumoral susceptibility signals in the differential diagnosis of solitary enhancing brain lesions: Preliminary study. AJNR Am J Neuroradiol 2009;30:1574-9.  Back to cited text no. 4
[PUBMED]    
5.Robinson R, Bhuta S. Susceptibility-weighted imaging: A major addition to the neuroimaging toolbox. J Neuroimaging 2011;21:309.  Back to cited text no. 5
[PUBMED]    
6.Park MJ, Kim HS, Jahng GH, Ryu CW, Park SM, Kim SY. Semiquantitative assessment of intratumoral susceptibility signals using non-contrast-enhanced high-field high-resolution susceptibility-weighted imaging in patients with gliomas: Comparison with MR perfusion imaging. AJNR Am J Neuroradiol 2009;30:1402-8.  Back to cited text no. 6
[PUBMED]    
7.Peters S, Knöß N, Wodarg F, Cnyrim C, Jansen O. Glioblastomas vs. lymphomas: More diagnostic certainty by using susceptibility-weighted imaging (SWI). Rofo 2012;184:713-8.  Back to cited text no. 7
    
8.Zhang W, Zhao J, Guo D, Zhong W, Shu J, Luo Y. Application of susceptibility weighted imaging in revealing intratumoral blood products and grading gliomas. J Radiol 2010;91:485-90.  Back to cited text no. 8
[PUBMED]    
9.Pinker K, Noebauer-Huhmann IM, Stavrou I, Hoeftberger R, Szomolanyi P, Karanikas G, et al. High-resolution contrast-enhanced, susceptibility-weighted MR imaging at 3T in patients with brain tumors: Correlation with positron-emission tomography and histopathologic findings. AJNR Am J Neuroradiol 2007;28:1280-6.  Back to cited text no. 9
    
10.Pinker K, Noebauer-Huhmann IM, Stavrou I, Hoeftberger R, Szomolanyi P, Weber M, et al. High-field, high-resolution, susceptibility-weighted magnetic resonance imaging: Improved image quality by addition of contrast agent and higher field strength in patients with brain tumors. Neuroradiology 2008;50:9-16.  Back to cited text no. 10
[PUBMED]    
11.Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility-weighted imaging: Technical aspects and clinical applications, part 2. AJNR Am J Neuroradiol 2009;30:232-52.  Back to cited text no. 11
[PUBMED]    
12.Tynninen O, Aronen HJ, Ruhala M, Paetau A, Von Boguslawski K, Salonen O, et al. MRI enhancement and microvascular density in gliomas. Correlation with tumor cell proliferation. Invest Radiol 1999;34:427-34.  Back to cited text no. 12
[PUBMED]    
13.Di Ieva A, Matula C, Grizzi F, Grabner G, Trattnig S, Tschabitscher M. Fractal analysis of the susceptibility weighted imaging patterns in malignant brain tumors during antiangiogenic treatment: Technical report on four cases serially imaged by 7 T magnetic resonance during a period of four weeks. World Neurosurg 2012;77:785.e11-21.  Back to cited text no. 13
    
14.Barth M, Nöbauer-Huhmann IM, Reichenbach JR, Mlynárik V, Schöggl A, Matula C, et al. High-resolution three-dimensional contrast-enhanced blood oxygenation level-dependent magnetic resonance venography of brain tumors at 3 Tesla: First clinical experience and comparison with 1.5 Tesla. Invest Radiol 2003;38:409-14.  Back to cited text no. 14
    
15.Johnson DR, Chang SM. Recent medical management of glioblastoma. Adv Exp Med Biol 2012;746:26-40.  Back to cited text no. 15
[PUBMED]    
16.Clarke J, Butowski N, Chang S. Recent advances in therapy for glioblastoma. Arch Neurol 2010;67:279-83.  Back to cited text no. 16
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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