High intratumoral susceptibility signal grade on susceptibility-weighted imaging: a risk factor for hemorrhage after stereotactic biopsy

Masahiro Tanji MD, PhD1, Yohei Mineharu MD, PhD1, Akihiko Sakata MD, PhD2, Sachi Okuchi MD, PhD2, Yasutaka Fushimi MD, PhD2, Masahiro Oishi MD, PhD1, Yukinori Terada MD, PhD1, Noritaka Sano MD, PhD1, Yukihiro Yamao MD, PhD1, Yoshiki Arakawa MD, PhD1, Kazumichi Yoshida MD, PhD1, and Susumu Miyamoto MD, PhD1
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  • 1 Department of Neurosurgery, and
  • | 2 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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OBJECTIVE

This study aimed to examine the association of preoperative intratumoral susceptibility signal (ITSS) grade with hemorrhage after stereotactic biopsy (STB).

METHODS

The authors retrospectively reviewed 66 patients who underwent STB in their institution. Preoperative factors including age, sex, platelet count, prothrombin time–international normalized ratio, activated thromboplastin time, antiplatelet agent use, history of diabetes mellitus and hypertension, target location, anesthesia type, and ITSS data were recorded. ITSS was defined as a dot-like or fine linear low signal within a tumor on susceptibility-weighted imaging (SWI) and was graded using a 3-point scale: grade 1, no ITSS within the lesion; grade 2, 1–10 ITSSs; and grade 3, ≥ 11 ITSSs. Postoperative final tumor pathology was also reviewed. The association between preoperative variables and the size of postoperative hemorrhage was examined.

RESULTS

Thirty-four patients were men and 32 were women. The mean age was 66.6 years. The most common tumor location was the frontal lobe (27.3%, n = 18). The diagnostic yield of STB was 93.9%. The most common pathology was lymphoma (36.4%, n = 24). The ITSS was grade 1 in 37 patients (56.1%), grade 2 in 14 patients (21.2%), and grade 3 in 15 patients (22.7%). Interobserver agreement for ITSS was almost perfect (weighted kappa = 0.87; 95% CI 0.77–0.98). Age was significantly associated with ITSS (p = 0.0075). Postoperative hemorrhage occurred in 17 patients (25.8%). Maximum hemorrhage diameter (mean ± SD) was 1.78 ± 1.35 mm in grade 1 lesions, 2.98 ± 2.2 mm in grade 2 lesions, and 9.51 ± 2.11 mm in grade 3 lesions (p = 0.01). Hemorrhage > 10 mm in diameter occurred in 10 patients (15.2%), being symptomatic in 3 of them. Four of 6 patients with grade 3 ITSS glioblastomas (66.7%) had postoperative hemorrhages > 10 mm in diameter. After adjusting for age, ITSS grade was the only factor significantly associated with hemorrhage > 10 mm (p = 0.029). Compared with patients with grade 1 ITSS, the odds of postoperative hemorrhage > 10 mm in diameter were 2.57 times higher in patients with grade 2 ITSS (95% CI 0.31–21.1) and 9.73 times higher in patients with grade 3 ITSS (95% CI 1.57–60.5).

CONCLUSIONS

ITSS grade on SWI is associated with size of postoperative hemorrhage after STB.

ABBREVIATIONS

APTT = activated partial thromboplastin time; FA = flip angle; FOV = field of view; GBM = glioblastoma; ITSS = intratumoral susceptibility signal; PT = prothrombin time; PT-INR = prothrombin time–international normalized ratio; STB = stereotactic biopsy; SWI = susceptibility-weighted imaging.

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