title: Quantitative susceptibility mapping differentiates between blood depositions and calcifications in patients with glioblastoma.
abstract: OBJECTIVE
  The application of susceptibility weighted imaging (SWI) in brain tumor imaging is mainly used to assess tumor-related "susceptibility based signals" (SBS). The origin of SBS in glioblastoma is still unknown, potentially representing calcifications or blood depositions. Reliable differentiation between both entities may be important to evaluate treatment response and to identify glioblastoma with oligodendroglial components that are supposed to present calcifications. Since calcifications and blood deposits are difficult to differentiate using conventional MRI, we investigated whether a new post-processing approach, quantitative susceptibility mapping (QSM), is able to distinguish between both entities reliably.
  
  
  METHODS
  SWI, FLAIR, and T1-w images were acquired from 46 patients with glioblastoma (14 newly diagnosed, 24 treated with radiochemotherapy, 8 treated with radiochemotherapy and additional anti-angiogenic medication). Susceptibility maps were calculated from SWI data. All glioblastoma were evaluated for the appearance of hypointense or hyperintense correlates of SBS on the susceptibility maps.
  
  
  RESULTS
  43 of 46 glioblastoma presented only hyperintense intratumoral SBS on susceptibility maps, indicating blood deposits. Additional hypointense correlates of tumor-related SBS on susceptibility maps, indicating calcification, were identified in 2 patients being treated with radiochemotherapy and in one patient being treated with additional anti-angiogenic medication. Histopathologic reports revealed an oligodendroglial component in one patient that presented calcifications on susceptibility maps.
  
  
  CONCLUSIONS
  QSM provides a quantitative, local MRI contrast, which reliably differentiates between blood deposits and calcifications. Thus, quantitative susceptibility mapping appears promising to identify rare variants of glioblastoma with oligodendroglial components non-invasively and may allow monitoring the role of calcification in the context of different therapy regimes.
authors.affiliation: Medical Physics Group, Institute of Diagnostic and Interventional Radiology I, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, Jena, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Deistung
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Schweser
authors.forename: Benedikt
authors.initials: B
authors.lastname: Wiestler
authors.forename: Mario
authors.initials: M
authors.lastname: Abello
authors.forename: Matthias
authors.initials: M
authors.lastname: Roethke
authors.forename: Felix
authors.initials: F
authors.lastname: Sahm
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wick
authors.forename: Armin Michael
authors.initials: AM
authors.lastname: Nagel
authors.forename: Sabine
authors.initials: S
authors.lastname: Heiland
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.forename: Martin
authors.initials: M
authors.lastname: Bendszus
authors.forename: Jürgen Rainer
authors.initials: JR
authors.lastname: Reichenbach
authors.forename: Alexander
authors.initials: A
authors.lastname: Radbruch
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009836:Oligodendroglia / Q000000981:diagnostic imaging / Q000378:metabolism; D011859:Radiography
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