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An update on susceptibility‐weighted imaging in brain gliomas

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Abstract

Susceptibility-weighted imaging (SWI) has become a standard component of most brain MRI protocols. While traditionally used for detecting and characterising brain hemorrhages typically associated with stroke or trauma, SWI has also shown promising results in glioma assessment. Numerous studies have highlighted SWI’s role in differentiating gliomas from other brain lesions, such as primary central nervous system lymphomas or metastases. Additionally, SWI aids radiologists in non-invasively grading gliomas and predicting their phenotypic profiles. Various researchers have suggested incorporating SWI as an adjunct sequence for predicting treatment response and for post-treatment monitoring. A significant focus of these studies is on the detection of intratumoural susceptibility signals (ITSSs) in gliomas, which are indicative of microhemorrhages and vessels within the tumour. The quantity, distribution, and characteristics of these ITSSs can provide radiologists with more precise information for evaluating and characterising gliomas. Furthermore, the potential benefits and added value of performing SWI after the administration of gadolinium-based contrast agents (GBCAs) have been explored. This review offers a comprehensive, educational, and practical overview of the potential applications and future directions of SWI in the context of glioma assessment.

Clinical relevance statement

SWI has proven effective in evaluating gliomas, especially through assessing intratumoural susceptibility signal changes, and is becoming a promising, easily integrated tool in MRI protocols for both pre- and post-treatment assessments.

Key Points

• Susceptibility-weighted imaging is the most sensitive sequence for detecting blood and calcium inside brain lesions.

• This sequence, acquired with and without gadolinium, helps with glioma diagnosis, characterisation, and grading through the detection of intratumoural susceptibility signals.

• There are ongoing challenges that must be faced to clarify the role of susceptibility-weighted imaging for glioma assessment.

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Abbreviations

ADC:

Apparent diffusion coefficient

CIPS:

Contrast-induced phase shift

CNS:

Central nervous system

DCE:

Dynamic contrast enhanced

DSC:

Dynamic susceptibility contrast

DWI:

Diffusion-weighted imaging

GBCA:

Gadolinium-based contrast agent

GRE:

Gradient echo

HGG:

High-grade glioma

IDH-1:

Isocitrate dehydrogenase 1

ITSS:

Intratumoural susceptibility signal

LGG:

Low-grade glioma

PCNSL:

Primary central nervous system lymphoma

PWI:

Perfusion-weighted imaging

SWI:

Susceptibility-weighted imaging

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  1. MRI Unit, Radiology Department, HT Medica, Carmelo Torres 2, 23007, Jaén, Spain

    Teodoro Martín-Noguerol & Antonio Luna

  2. Department of Radiology, Povisa Hospital (Ribera Salud Group), Vigo, Spain

    Eloísa Santos-Armentia

  3. Department of Neuroradiology, University Hospital, 12 de Octubre, Madrid, Spain

    Ana Ramos

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Martín-Noguerol, T., Santos-Armentia, E., Ramos, A. et al. An update on susceptibility‐weighted imaging in brain gliomas. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10703-w

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