Susceptibility-Weighted MR Imaging in the differentiation between high and low grade astrocytomas of the brain Poster No.: C-995 Congress: ECR 20 Type: Educational Exhibit Authors: M. Gavrilov, B. Vasi#, S. Lavrnic, D. Damjanovic, I. Nikolic, M. 2 Macvanski, B. Banko, D. Grujicic, T. Stosic-Opincal ; Belgrade/ 2 RS, Beograd/RS Keywords: Neoplasia, MR, Neuroradiology brain DOI: 0.594/ecr20/C-995 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page of 8
Learning objectives To show the role of Susceptibility-Weighted MR Imaging (SWI) in characterizing of brain astrocytomas and to find a correlation between the presence of intratumoral susceptibility signals and the tumor grade. Background Conventional magnetic resonance (MR) imaging has a number of limitations in the diagnosis of brain tumors. SWI was reported as being able to demonstrate the magnetic susceptibility differences of various tissues and to increase the sensitivity to the susceptibility effect of microvenous structures and blood products and has been applied mainly in the assessment of vascular and hemorrhagic brain disorders and cavernous malformations. In gliomas, angiogenesis and microhemorrhagies have been shown to be associated with the tumor viability and higher tumor grade. Imaging findings OR Procedure details Twenty one patients with histologically proved supratentorial and infratentorial brain astrocytomas were retrospectively evaluated with contrast-enhanced MR imaging, diffusion-weighted imaging (DWI) and SWI. There were glioblastoma multiformes, 4 anaplastic astrocytomas and 6 low grade astrocytomas. All tumors were without presence of hemorrhage on T and T2-weighted sequences. MRI studies were performed on a.5t superconducting system. Images were reviewed by three neuroradiologists. Intratumoral susceptibility signals were defined as focal low signal intensity structure, with or without conglomeration, seen within the tumor on SWI. The frequency and formation of intralesional susceptibility signals in all of the images were evaluated and correlated with tumor grade as determined by histopathology. The results are shown on Table. The higher tumor grade correlates with number of intralesional susceptibility signals. Exception is WHO grade I tumor, pylocitic astrocytoma (Fig. 5) because of its highly vascular tissue with glomeruloid features. Images for this section: Page 2 of 8
Fig. : Low grade astrocytoma (WHO Grade II) of the right temporal lobe: SWI images have shown no intralesional susceptibility signals. Fig. 2: Anaplastic astrocytoma (WHO Grade III) in 50-year-old male. Tumor was infiltrated parts of right frontal, temporal and insular region. There have been counted 4 intralesional susceptibility signals. Page 3 of 8
Fig. 3: Left parietal-temporal tumor in 53-year-old female: Anaplastic astrocytoma (WHO Grade III). Fig. 4: Left temporal tumor in 64-year-old male: Glioblastoma multiforme. Note large number of intralesional susceptibility signals caused by neoangiogenesis.. Page 4 of 8
Fig. 5: Infratentorial glioma in 22-year-old female: pylocitic astrocytoma (WHO grade I). SWI images show many intralesional susceptibility signals. Fig. 6: A tumor of left temporal lobe in 6-year-old male: Anaplastic astrocytoma Page 5 of 8
Fig. 7: A tumor of left frontal and temporal lobe in 38-year-old male: Glioblastoma multiforme. There have been counted intralesional susceptibility signals. Fig. 8: Table. The average number of intralesional susceptibility signals in different tumor grades Page 6 of 8
Conclusion Our results suggest that SWI may be helpful as an additional MRI sequence in the differentiation of astrocytic tumors type and grade before resection. Personal Information Dr. Mihail Gavrilov Radiology Department University Clinical Center of Serbia Pasterova 2 000 Belgrade Serbia mihail.gavrilov@gmail.com References. H.S. Kim, G.H. Jahng, C.W. Ryu, and S.Y. Kim. Added Value and Diagnostic Performance of Intratumoral Susceptibility Signals in the Differential Diagnosis of Solitary Enhancing Brain Lesions: Preliminary Study. AJNR Am. J. Neuroradiol., Sep 2009; 30: 574-579. 2. A. Rauscher, J. Sedlacik, M. Barth, H.J. Mentzel, and J. R. Reichenbach. Magnetic Susceptibility-Weighted MR Phase Imaging of the Human Brain AJNR Am. J. Neuroradiol., Apr 2005; 26: 736-742. 3. K. Pinker, I.M. Noebauer-Huhmann, I. Stavrou, R. Hoeftberger, P. Szomolanyi, G. Karanikas, M. Weber, A. Stadlbauer, E. Knosp, K. Friedrich, and S. Trattnig. HighResolution 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., Aug 2007; 28: 280-286. Page 7 of 8
4. O. Tynninen, HJ. Aronen, M. Ruhala et al. MRI enhancement and microvascular density in gliomas. Correlation with tumor cell proliferation. Invest Radiol 999;34:427-34. 5. N.A. Butowski, P.K. Sneed, S.M.Chang. Diagnosis and treatment of recurrent highgrade astrocytoma. J Clin Oncol 2006;24:273-80. 6. G.A. Christoforidis, A. Kangarlu, A.M. Abduljalil et al. Susceptibility-based imaging of glioblastoma microvascularity at 8 T: correlation of MR imaging and postmortem pathology. AJNR Am J Neuroradiol 2004;25:756-60. 7. R.N.K. Nandigam, A. Viswanathan, P. Delgado, M.E. Skehan, E.E. Smith, J. Rosand, S.M. Greenberg, and B.C. Dickerson. MR Imaging Detection of Cerebral Microbleeds: Effect of Susceptibility-Weighted Imaging, Section Thickness, and Field Strength. AJNR Am. J. Neuroradiol., February, 2009; 30(2): 338-343. 8. L. Saitta, O. Heese, A-F. Förster, J. Matschke, S. Siemonsen, L. Castellan et al. Signal intensity in T2* magnetic resonance imaging is related to brain glioma grade. Eur Radiol. DOI 0.007/s00330-00-2004-3. Page 8 of 8