Accuracy of SWI sequences compared to T2*-weighted gradient echo sequences in the detection of cerebral cavernous malformations in the familial form

Gianvincenzo Sparacia; Claudia Speciale; Aurelia Banco; Francesco Bencivinni; Massimo Midiri

doi:10.1177/1971400916665376

Accuracy of SWI sequences compared to T2*-weighted gradient echo sequences in the detection of cerebral cavernous malformations in the familial form

Neuroradiol J. 2016 Oct;29(5):326-35. doi: 10.1177/1971400916665376. Epub 2016 Aug 22.

Authors

Gianvincenzo Sparacia¹, Claudia Speciale², Aurelia Banco², Francesco Bencivinni², Massimo Midiri²

Affiliations

¹ Department of Radiology, University of Palermo, Palermo, Italy sparacia@yahoo.com.
² Department of Radiology, University of Palermo, Palermo, Italy.

Abstract

Purpose: The purpose of this study was to assess the accuracy of susceptibility-weighted imaging (SWI), compared with T2*-weighted gradient echo (GRE) imaging in assessing cerebral cavernous malformations.

Materials and methods: We retrospectively evaluated 21 patients with a familial form of cavernous malformation. Magnetic resonance (MR) protocol included non-enhanced and contrast-enhanced fast-spin echo (FSE) T1-weighted sequences, FSE T2-weighted sequences, fluid-attenuated inversion-recovery (FLAIR), GRE T2*-weighted and SWI sequences. Images were reviewed in consensus by two expert neuroradiologists to assess the location, number, size and conspicuity of the lesions on T2*-weighted GRE and SWI sequences. Statistical differences in the number, size and conspicuity of the lesions seen on the SWI images and the T2*-weighted GRE images were assessed with the nonparametric Wilcoxon signed rank test.

Results: The number of cavernous malformations was significantly higher (p < .001) on the SWI images (n = 152) than on T2*-weighted GRE images (n = 56). Lesion size was significantly higher (p < .001) on SWI images (mean: 0.4 cm, SD ± 0.55) than on T2*-weighted GRE sequences (mean: 0.2 cm, SD ± 0.51) and the differences were statistically significant (p < .001). Lesion conspicuity was significant higher (p < .001) on SWI than on T2*-weighted GRE images. In one patient who underwent a 2-month follow-up for the onset of neurologic symptoms related to cerebral hemorrhage, a cerebral hematoma was identified at the site of a cerebral cavernous malformation that was demonstrated only on the SWI images in the previous MR examination.

Conclusions: The SWI sequence, being more sensitive to substances which distort the local magnetic field than the GRE T2*W sequence, showed a higher sensitivity in identifying cerebral cavernous malformations. Thus, routine clinical neuroimaging protocol should contain SWI sequences to evaluate patients with (or suspected) cerebral cavernous malformations.

Keywords: Cerebral cavernous malformation; T2*-weighted gradient echo sequence; diagnosis; imaging; susceptibility-weighted imaging.

MeSH terms

Adult
Aged
Echo-Planar Imaging / methods*
Female
Hemangioma, Cavernous, Central Nervous System / diagnostic imaging*
Humans
Image Enhancement
Image Processing, Computer-Assisted*
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Statistics as Topic