The Sensitivity and Specificity of Susceptibility Weighted Imaging Phase (Swip) in Detecting Intracranial Large Artery Calcium Stenosis Compared to Cone Beam CT

Abstract

Introduction: Intracranial calcifications are common and often associated with advanced stages of atherosclerosis. Studies estimating the prevalence of intracranial calcifications using other imaging modalities are common, however, studies comparing the diagnostic accuracies of cone-beam computed tomography (CBCT) and susceptibility-weighted imaging (SWI) and generated scoring systems for SWI are not well established. Aims: The objectives of the present study are to identify locations of intracranial calcifications; estimate the sensitivity and specificity rates for each intracranial vessel and each modality; estimate the sensitivity and specificity rates for diagnosing each grade of stenosis for each modality; and generate cutoff value for predicting each grade of intracranial stenosis and for each modality; as well as to develop a scoring system for estimating intracranial stenosis using SWI. Material and Methods: The study employs a prospective cross-sectional study design to collect brain data from 146 stroke patients who had initially undergone CBCT and SWI examinations. Data were collected using pro forma from January 2021 to December 2022 at Hospital Pengajar Universiti Putra Malaysia. Results: The results show an estimated prevalence of intracranial calcification of 87.7% and 92.5% for CBCT and SWI respectively. Regarding intracranial calcium grades, the prevalence of minimum – mild, moderate, and severe grade stenosis were 18.5%, 58,9%, and 10.3% respectively for CBCT and 2.7%, 33.8%, and 57.5% for SWI. Further, the results revealed that CBCT attained a sensitivity of 100% for the anterior cerebral artery, 71% for the middle cerebral artery, and 100% for the vertebral artery as well as a specificity of 90%, 80%, and 42% for the anterior cerebral artery, middle cerebral artery, and vertebral artery respectively. However, with the SWI modality, basilar, vertebral, and middle cerebral arteries reached a sensitivity of 90%, 63%, and 87% and a specificity of 82%, 95%, and 59%. Conclusion: In conclusion, both CBCT and SWI demonstrate reliable means of detecting intracranial calcifications and vessel stenosis with SWI outperforming CBCT.