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Haemorrhage and Calcification on Susceptibility-Weighted Imaging

A Quick and Reliable Qualitative Technique for Differentiating Lesions with Ambiguous Phase

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Abstract

Purpose

Haemorrhage and calcification can be qualitatively distinguished on susceptibility-weighted imaging (SWI) using phase information, but it is unclear how to make this distinction in a subset of lesions with ambiguous phase, containing a mixture of positive and negative values. This work investigates the validity of qualitative phase assessment at the cranial or caudal margins in classifying such lesions as haemorrhagic or calcific, when quantitative susceptibility map** is not available to the neuroradiologist.

Methods

In a retrospective review of magnetic resonance imaging examinations acquired between July 2015 and November 2019, 87 lesions with ambiguous phase which could be confidently determined to be haemorrhagic or calcific were identified. Two blinded neuroradiologists independently classified these lesions as haemorrhagic or calcific using 3 approaches: qualitative phase assessment at the lesions’ cranial or caudal margins, dominant phase, and in-plane margins. Combined sensitivities and specificities of these analyses were calculated using a generalised linear mixed model with random effects for reader.

Results

Assessment at the cranial or caudal margins achieved a sensitivity of 100% for haemorrhage and calcification, which was significantly superior (p < 0.05) to dominant phase assessment with sensitivities of 52% for haemorrhage (95% confidence interval, CI 43–61%) and 54% for calcification (95% CI 42–66%), as well as in-plane margin assessment with 28% (95% CI 18–38%) and 46% (95% CI 36–56%).

Conclusion

Haemorrhage and calcification can be reliably distinguished in lesions with ambiguous phase on SWI by qualitative review of the phase signal at the cranial or caudal margins.

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Acknowledgements

The authors would like to thank Dr Nancy Briggs BS MA PhD from Stats Central, UNSW Sydney for statistical analyses.

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Authors and Affiliations

  1. Medical Imaging Department, Prince of Wales Hospital, Randwick, NSW, 2031, Australia

    Kevin L. Tay, Stewart R. Leason, Laughlin C. Dawes & Sophia L. Thomas

  2. Prince of Wales Clinical School, UNSW, Sydney, NSW, 2052, Australia

    Kevin L. Tay & Laughlin C. Dawes

  3. Research Imaging New South Wales, UNSW, Sydney, NSW, 2052, Australia

    Claudia M. Hillenbrand

Authors
  1. Kevin L. Tay
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  2. Stewart R. Leason
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Contributions

Conceptualisation, methodology and design: Kevin L Tay with support from Stewart R Leason and Laughlin C Dawes. Material preparation and data collection: Stewart R Leason with support from Kevin L Tay, Laughlin C Dawes and Sophia L Thomas. Analysis: Kevin L Tay and Stewart R Leason. First draft of manuscript: Kevin L Tay and Claudia M Hillenbrand. All authors read and approved the final manuscript

Corresponding author

Correspondence to Kevin L. Tay.

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Conflict of interest

K.L. Tay, S.R. Leason, L.C. Dawes, S.L. Thomas and C.M. Hillenbrand declare that they have no competing interests.

Ethical standards

Institutional Review Board approval was obtained. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the South Eastern Sydney Local Health District Human Research Ethics Committee. Participants of this study did not agree for their data to be shared publicly, so supporting data are not available beyond summary data. A waiver of individual patient consent was granted by the ethics committee as the study used anonymised, non-identifiable, already acquired information.

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Tay, K.L., Leason, S.R., Dawes, L.C. et al. Haemorrhage and Calcification on Susceptibility-Weighted Imaging. Clin Neuroradiol 32, 705–715 (2022). https://doi.org/10.1007/s00062-021-01094-2

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  • DOI: https://doi.org/10.1007/s00062-021-01094-2

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