Internal Cerebral Vein in Susceptibility-Weighted Imaging: A Reliable Tool to Differentiate Among Calcification, Microbleed, and Gross Hemorrhage in Brain Tumors.

Abstract

Background and objective Susceptibility-weighted imaging (SWI) sequence is crucial for brain MRI examinations, as it is equipped with a high sensitivity to detect calcification, microbleed, and gross hemorrhage. Intracranial venous structures such as the superior sagittal sinus (SSS) and cortical veins are used as reference structures in phase image SWI to differentiate diamagnetic and paramagnetic substances. Our study focuses on the internal cerebral vein (ICV) as another reliable reference structure. We aimed to analyze the diagnostic accuracy and detectability of calcification and hemorrhagic components in brain tumors using ICV, cortical veins, and SSS as references on phase image SWI, with CT scans for comparison. Material and methods A retrospective review of calcification and hemorrhagic components in brain tumors was conducted using MRI and CT from January 2017 to June 2023. Results The study included a total of 192 patients with brain tumors. For calcification components (63 cases), ICV and cortical veins as reference structures showed excellent sensitivity (96.8%), specificity (100%), and accuracy (98.9%). SSS demonstrated slightly lower detectability but maintained high sensitivity (96.5%), specificity (100%), and accuracy (98.8%) levels. No statistical differences were noted among these reference structures (p>0.05) and excellent interobserver agreement (Cohen's Kappa of 1) was observed. Conclusions The ICV is located in the central image, is large, without any nearby arteries, and is easy to identify using SWI phase images. Using the ICV as a reference to characterize intratumoral calcification, microbleed, and hemorrhage demonstrates high accuracy and detectability. With its findings of excellent interobserver agreement, our study will be of immense benefit to radiologists.