Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke

Sven P.R. Luijten; Nadinda A.M. van der Ende; Sandra A.P. Cornelissen; Leo Kluijtmans; Antonius van Hattem; Geert Lycklama a Nijeholt; Alida A. Postma; Reinoud P.H. Bokkers; Lars Thomassen; Ulrike Waje-Andreassen; Nicola Logallo; Serge Bracard; Benjamin Gory; Bob Roozenbeek; Diederik W.J. Dippel; Aad van der Lugt

doi:10.1007/s00234-023-03180-3

Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke

Sven P.R. Luijten^*, Nadinda A.M. van der Ende, Sandra A.P. Cornelissen, Leo Kluijtmans, Antonius van Hattem, Geert Lycklama a Nijeholt, Alida A. Postma, Reinoud P.H. Bokkers, Lars Thomassen, Ulrike Waje-Andreassen, Nicola Logallo, Serge Bracard, Benjamin Gory, Bob Roozenbeek, Diederik W.J. Dippel, Aad van der Lugt

^*Corresponding author for this work

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Abstract

Purpose:

Diffusion-weighted imaging (DWI) b0 may be able to substitute T2*-weighted gradient echo (GRE) or susceptibility-weighted imaging (SWI) in case of comparable detection of intracranial hemorrhage (ICH), thereby reducing MRI examination time. We evaluated the diagnostic accuracy of DWI b0 compared to T2*GRE or SWI for detection of ICH after reperfusion therapy for ischemic stroke.

Methods:

We pooled 300 follow-up MRI scans acquired within 1 week after reperfusion therapy. Six neuroradiologists each rated DWI images (b0 and b1000; b0 as index test) of 100 patients and, after a minimum of 4 weeks, T2*GRE or SWI images (reference standard) paired with DWI images of the same patients. Readers assessed the presence of ICH (yes/no) and type of ICH according to the Heidelberg Bleeding Classification. We determined the sensitivity and specificity of DWI b0 for detection of any ICH, and the sensitivity for detection of hemorrhagic infarction (HI1 & HI2) and parenchymal hematoma (PH1 & PH2).

Results:

We analyzed 277 scans of ischemic stroke patients with complete image series and sufficient image quality (median age 65 years [interquartile range, 54–75], 158 [57%] men). For detection of any ICH on DWI b0, the sensitivity was 62% (95% CI: 50–76) and specificity 96% (95% CI: 93–99). The sensitivity of DWI b0 was 52% (95% CI: 28–68) for detection of hemorrhagic infarction and 84% (95% CI: 70–92) for parenchymal hematoma.

Conclusion:

DWI b0 is inferior for detection of ICH compared to T2*GRE/SWI, especially for smaller and more subtle hemorrhages. Follow-up MRI protocols should include T2*GRE/SWI for detection of ICH after reperfusion therapy.

Original language	English
Pages (from-to)	1649-1655
Number of pages	7
Journal	Neuroradiology
Volume	65
Issue number	11
DOIs	https://doi.org/10.1007/s00234-023-03180-3
Publication status	Published - Nov 2023

Bibliographical note

Funding Information:
AP reports institutional grants from Siemens Healthineers and Bayer Healthcare. RB reports funding from the Netherlands Organisation for Health Research and Development, the Dutch Ministry of Economic Affairs and Climate Policy, and an unrestricted grant from Siemens Healthineers. UWA reports funding from “Helse-Vest” and from the University of Bergen for research. DD and AvdL report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. The other authors report no conflicts.

Publisher Copyright:
© 2023, The Author(s).

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Cite this

Luijten, S. P. R., van der Ende, N. A. M., Cornelissen, S. A. P., Kluijtmans, L., van Hattem, A., Lycklama a Nijeholt, G., Postma, A. A., Bokkers, R. P. H., Thomassen, L., Waje-Andreassen, U., Logallo, N., Bracard, S., Gory, B., Roozenbeek, B., Dippel, D. W. J., & van der Lugt, A. (2023). Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke. Neuroradiology, 65(11), 1649-1655. https://doi.org/10.1007/s00234-023-03180-3

@article{33617c2f05974a7ba58cf0668cb5abc9,

title = "Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke",

abstract = "Purpose: Diffusion-weighted imaging (DWI) b0 may be able to substitute T2*-weighted gradient echo (GRE) or susceptibility-weighted imaging (SWI) in case of comparable detection of intracranial hemorrhage (ICH), thereby reducing MRI examination time. We evaluated the diagnostic accuracy of DWI b0 compared to T2*GRE or SWI for detection of ICH after reperfusion therapy for ischemic stroke. Methods: We pooled 300 follow-up MRI scans acquired within 1 week after reperfusion therapy. Six neuroradiologists each rated DWI images (b0 and b1000; b0 as index test) of 100 patients and, after a minimum of 4 weeks, T2*GRE or SWI images (reference standard) paired with DWI images of the same patients. Readers assessed the presence of ICH (yes/no) and type of ICH according to the Heidelberg Bleeding Classification. We determined the sensitivity and specificity of DWI b0 for detection of any ICH, and the sensitivity for detection of hemorrhagic infarction (HI1 & HI2) and parenchymal hematoma (PH1 & PH2). Results: We analyzed 277 scans of ischemic stroke patients with complete image series and sufficient image quality (median age 65 years [interquartile range, 54–75], 158 [57%] men). For detection of any ICH on DWI b0, the sensitivity was 62% (95% CI: 50–76) and specificity 96% (95% CI: 93–99). The sensitivity of DWI b0 was 52% (95% CI: 28–68) for detection of hemorrhagic infarction and 84% (95% CI: 70–92) for parenchymal hematoma. Conclusion: DWI b0 is inferior for detection of ICH compared to T2*GRE/SWI, especially for smaller and more subtle hemorrhages. Follow-up MRI protocols should include T2*GRE/SWI for detection of ICH after reperfusion therapy.",

author = "Luijten, {Sven P.R.} and {van der Ende}, {Nadinda A.M.} and Cornelissen, {Sandra A.P.} and Leo Kluijtmans and {van Hattem}, Antonius and {Lycklama a Nijeholt}, Geert and Postma, {Alida A.} and Bokkers, {Reinoud P.H.} and Lars Thomassen and Ulrike Waje-Andreassen and Nicola Logallo and Serge Bracard and Benjamin Gory and Bob Roozenbeek and Dippel, {Diederik W.J.} and {van der Lugt}, Aad",

note = "Funding Information: AP reports institutional grants from Siemens Healthineers and Bayer Healthcare. RB reports funding from the Netherlands Organisation for Health Research and Development, the Dutch Ministry of Economic Affairs and Climate Policy, and an unrestricted grant from Siemens Healthineers. UWA reports funding from “Helse-Vest” and from the University of Bergen for research. DD and AvdL report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = nov,

doi = "10.1007/s00234-023-03180-3",

language = "English",

volume = "65",

pages = "1649--1655",

journal = "Neuroradiology",

issn = "0028-3940",

publisher = "Springer-Verlag",

number = "11",

}

Luijten, SPR , van der Ende, NAM , Cornelissen, SAP, Kluijtmans, L, van Hattem, A, Lycklama a Nijeholt, G, Postma, AA, Bokkers, RPH, Thomassen, L, Waje-Andreassen, U, Logallo, N, Bracard, S, Gory, B, Roozenbeek, B , Dippel, DWJ & van der Lugt, A 2023, 'Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke', Neuroradiology, vol. 65, no. 11, pp. 1649-1655. https://doi.org/10.1007/s00234-023-03180-3

Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke. / Luijten, Sven P.R.; van der Ende, Nadinda A.M.; Cornelissen, Sandra A.P. et al.
In: Neuroradiology, Vol. 65, No. 11, 11.2023, p. 1649-1655.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke

AU - Luijten, Sven P.R.

AU - van der Ende, Nadinda A.M.

AU - Cornelissen, Sandra A.P.

AU - Kluijtmans, Leo

AU - van Hattem, Antonius

AU - Lycklama a Nijeholt, Geert

AU - Postma, Alida A.

AU - Bokkers, Reinoud P.H.

AU - Thomassen, Lars

AU - Waje-Andreassen, Ulrike

AU - Logallo, Nicola

AU - Bracard, Serge

AU - Gory, Benjamin

AU - Roozenbeek, Bob

AU - Dippel, Diederik W.J.

AU - van der Lugt, Aad

N1 - Funding Information: AP reports institutional grants from Siemens Healthineers and Bayer Healthcare. RB reports funding from the Netherlands Organisation for Health Research and Development, the Dutch Ministry of Economic Affairs and Climate Policy, and an unrestricted grant from Siemens Healthineers. UWA reports funding from “Helse-Vest” and from the University of Bergen for research. DD and AvdL report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. The other authors report no conflicts. Publisher Copyright: © 2023, The Author(s).

PY - 2023/11

Y1 - 2023/11

N2 - Purpose: Diffusion-weighted imaging (DWI) b0 may be able to substitute T2*-weighted gradient echo (GRE) or susceptibility-weighted imaging (SWI) in case of comparable detection of intracranial hemorrhage (ICH), thereby reducing MRI examination time. We evaluated the diagnostic accuracy of DWI b0 compared to T2*GRE or SWI for detection of ICH after reperfusion therapy for ischemic stroke. Methods: We pooled 300 follow-up MRI scans acquired within 1 week after reperfusion therapy. Six neuroradiologists each rated DWI images (b0 and b1000; b0 as index test) of 100 patients and, after a minimum of 4 weeks, T2*GRE or SWI images (reference standard) paired with DWI images of the same patients. Readers assessed the presence of ICH (yes/no) and type of ICH according to the Heidelberg Bleeding Classification. We determined the sensitivity and specificity of DWI b0 for detection of any ICH, and the sensitivity for detection of hemorrhagic infarction (HI1 & HI2) and parenchymal hematoma (PH1 & PH2). Results: We analyzed 277 scans of ischemic stroke patients with complete image series and sufficient image quality (median age 65 years [interquartile range, 54–75], 158 [57%] men). For detection of any ICH on DWI b0, the sensitivity was 62% (95% CI: 50–76) and specificity 96% (95% CI: 93–99). The sensitivity of DWI b0 was 52% (95% CI: 28–68) for detection of hemorrhagic infarction and 84% (95% CI: 70–92) for parenchymal hematoma. Conclusion: DWI b0 is inferior for detection of ICH compared to T2*GRE/SWI, especially for smaller and more subtle hemorrhages. Follow-up MRI protocols should include T2*GRE/SWI for detection of ICH after reperfusion therapy.

AB - Purpose: Diffusion-weighted imaging (DWI) b0 may be able to substitute T2*-weighted gradient echo (GRE) or susceptibility-weighted imaging (SWI) in case of comparable detection of intracranial hemorrhage (ICH), thereby reducing MRI examination time. We evaluated the diagnostic accuracy of DWI b0 compared to T2*GRE or SWI for detection of ICH after reperfusion therapy for ischemic stroke. Methods: We pooled 300 follow-up MRI scans acquired within 1 week after reperfusion therapy. Six neuroradiologists each rated DWI images (b0 and b1000; b0 as index test) of 100 patients and, after a minimum of 4 weeks, T2*GRE or SWI images (reference standard) paired with DWI images of the same patients. Readers assessed the presence of ICH (yes/no) and type of ICH according to the Heidelberg Bleeding Classification. We determined the sensitivity and specificity of DWI b0 for detection of any ICH, and the sensitivity for detection of hemorrhagic infarction (HI1 & HI2) and parenchymal hematoma (PH1 & PH2). Results: We analyzed 277 scans of ischemic stroke patients with complete image series and sufficient image quality (median age 65 years [interquartile range, 54–75], 158 [57%] men). For detection of any ICH on DWI b0, the sensitivity was 62% (95% CI: 50–76) and specificity 96% (95% CI: 93–99). The sensitivity of DWI b0 was 52% (95% CI: 28–68) for detection of hemorrhagic infarction and 84% (95% CI: 70–92) for parenchymal hematoma. Conclusion: DWI b0 is inferior for detection of ICH compared to T2*GRE/SWI, especially for smaller and more subtle hemorrhages. Follow-up MRI protocols should include T2*GRE/SWI for detection of ICH after reperfusion therapy.

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DO - 10.1007/s00234-023-03180-3

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SN - 0028-3940

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Luijten SPR , van der Ende NAM , Cornelissen SAP, Kluijtmans L, van Hattem A, Lycklama a Nijeholt G et al. Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke. Neuroradiology. 2023 Nov;65(11):1649-1655. doi: 10.1007/s00234-023-03180-3

Comparison of diffusion weighted imaging b0 with T2*-weighted gradient echo or susceptibility weighted imaging for intracranial hemorrhage detection after reperfusion therapy for ischemic stroke

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