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

BACKGROUND AND PURPOSE: It has been reported that high-resolution susceptibility-weighted imaging (HR-SWI) may demonstrate brain tumor vascularity. We determined whether the degree of intratumoral susceptibility signal intensity (ITSS) on HR-SWI correlates with maximum relative cerebral blood volume (rCBVmax) and to compare its diagnostic accuracy for glioma grading with that of dynamic susceptibility contrast (DSC) perfusion MR imaging. MATERIALS AND METHODS: Forty-one patients with diffuse astrocytomas underwent both non-contrast-enhanced HR-SWI and DSC at 3T. We correlated the degree and morphology of ITSS with rCBVmax within the same tumor segment. The degree of ITSS and rCBVmax were compared among 3 groups with different histopathologic grades. Spearman correlation coefficients were determined between the degree of ITSS, rCBVmax, and glioma grade. Receiver operating characteristic (ROC) curve analyses were performed to determine the diagnostic accuracy for glioma grading. RESULTS: The degree of ITSS showed a significant correlation with the value of rCBVmax in the same tumor segments (r = 0.72, P < .0001). However, the areas of densely prominent ITSSs did not accurately correspond with those of rCBVmax. Spearman correlation coefficients between ITSS degree and glioma grade were 0.88 (95% confidence interval, 0.79-0.94). In the ROC curve analysis of histopathologic correlation by using the degree of ITSS, the optimal sensitivity, specificity, positive predictive value, and negative predictive value for determining a high-grade tumor were 85.2%, 92.9%, 95.8%, and 76.5%, respectively. CONCLUSIONS: The degree of ITSS shows a significant correlation with the value of rCBVmax in the same tumor segments, and its diagnostic performance for glioma grading is comparable with that of DSC.