The Value of Two-Dimensional Gradient Echo Imaging (2D-GRE) and Susceptibility Weighted Imaging (SWI) in the Assessment of Hemorrhagic Lesions in Diffuse Brainstem Gliomas Treated with Radiation and Antiangiogenic Therapy

Ulrike Lbel¹, Jan Sedlacik¹, Mehmet Kocak², Alberto Broniscer³, Claudia M. Hillenbrand¹, Zoltn Patay¹

Two-dimensional gradient-echo imaging and susceptibility-weighted imaging (SWI) enhance visualization of magnetically susceptible substances such as hemorrhage and calcification. In patients with diffuse pontine glioma treated with conformal radiation and vandetanib, an angiogenesis inhibitor, both techniques were compared regarding their accuracy and validity for detecting hemorrhagic lesions. Image analysis and interpretation were found to be more accurate and straightforward with SWI as fewer lesions were missed or misinterpreted. We found that both techniques benefited from the availability of phase images, especially for differentiation of hemorrhage from calcification. However, SWI will likely become the new gold standard for imaging magnetically susceptible substances.