Benefits of contrast-enhanced SWI in patients with glioblastoma multiforme

Eur Radiol. 2013 Oct;23(10):2868-79. doi: 10.1007/s00330-013-2895-x. Epub 2013 Aug 1.


Introduction: SWI can help to identify high-grade gliomas (HGG). The objective of this study was to analyse SWI and CE-SWI characteristics, i.e. the relationship between contrast-induced phase shifts (CIPS) and intratumoral susceptibility signals (ITSS) and their association with tumour volume in patients with glioblastoma multiforme (GBM).

Materials and methods: MRI studies of 29 patients were performed to evaluate distinct susceptibility signals comparing SWI and CE-SWI characteristics. The relationship between these susceptibility signals and CE-T1w tumour volume was analysed by using Spearman's rank correlation coefficient and Kruskal-Wallis-test. Tumour biopsies of different susceptibility signals were performed in one patient.

Results: Comparison of SWI and CE-SWI demonstrated different susceptibility signals. Susceptibility signals visible on SWI images are consistent with ITSS; those only seen on CE-SWI were identified as CIPS. Correlation with CE-T1w tumour volume revealed that CIPS were especially present in small or medium-sized GBM (Spearman's rho r = 0.843, P < 0.001). Histology identified the area with CIPS as the tumour invasion zone, while the area with ITSS represented micro-haemorrhage, highly pathological vessels and necrosis.

Conclusion: CE-SWI adds information to the evaluation of GBM before therapy. It might have the potential to non-invasively identify the tumour invasion zone as demonstrated by biopsies in one case.

Key points: • MRI is used to help differentiate between low- and high-grade gliomas. • Contrast-enhanced susceptibility-weighted MRI (CE-SWI) helps to identify patients with glioblastoma multiforme. • CE-SWI delineates the susceptibility signal (CIPS and ITSS) more than the native SWI. • CE-SWI might have the potential to non-invasively identify the tumour invasion zone.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Brain Neoplasms / pathology*
  • Contrast Media
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Glioblastoma / pathology*
  • Humans
  • Image Enhancement / methods*
  • Image Interpretation, Computer-Assisted / methods*
  • Male
  • Middle Aged
  • Organometallic Compounds*
  • Reproducibility of Results
  • Sensitivity and Specificity


  • Contrast Media
  • Organometallic Compounds
  • gadobutrol