Comparison of susceptibility-weighted angiography (SWAN) and T2 gradient-echo sequences for the detection of acute cerebral venous thrombosis. Issue 2 (April 2023)

• Record Type: Journal Article
• Authors: Boukobza, Monique; Guinebert, Sylvain; Laissy, Jean-Pierre
• Is Part Of: Neuroradiology journal. Volume 36:Issue 2(2023)
• Page Start: 148
• Page End: 157
• Publication Date: 2023-04
• Subjects: GRE T2-T2* -- susceptibility weighted angiography (SWAN) sequence -- susceptibility-weighted imaging -- cortical venous thrombosis -- venous sinus thrombosis; Nervous system -- Radiography -- Periodicals; Neuroradiography -- Periodicals; Electronic journals; 616.804757
• DOI: 10.1177/19714009221109885
• Languages: English
• ISSNs: 1971-4009

Abstract

Objectives: To assess the diagnostic accuracy and lesion conspicuity of susceptibility-weighted angiography (SWAN) and T2* for the clot detection in acute cerebral venous thrombosis (CVT) by comparison with contrast-enhanced MR venography. Methods: Venous thrombi detection and conspicuity were assessed by two readers for 18 venous segments on both T2*, SWAN source images, 2D SWAN reformats matching with T2*, and 3D SWAN images (SWAN-MinIP). Images obtained with the three reading techniques were systematically scored and compared to CE MRV findings, in a blinded fashion, per patient and per segment, and compared to each other. Results: In 30 patients, 137 thrombosed venous segments were evaluated. The sensitivity of T2*, SWAN source images, 2D SWAN, and SWAN MinIP were, respectively, of 89.3%/82.1%, 82.1%, and 82.1% for dural sinus thrombosis and of 100%/100%/100%/96.6% for cortical venous thrombosis. There were significant differences in thrombus detection between T2* and SWAN: T2* versus SWAN source images and 2D SWAN ( p = 0.04) and versus SWAN MinIP ( p = 0.03). There were no significant differences between the three modalities of SWAN images. T2* was more sensitive than all SWAN images for both sigmoid sinus thrombosis and intracranial internal jugular vein thrombosis ( p = 0.04). Inter-observer agreement was slightly superior with T2* ( p < 0.05). Conclusion: In this small cohort, SWAN sequence at 3T did not yield additional value for thrombus detection in acute CVT compared to T2*. This study highlights SWAN's greatest weakness both for diagnostic accuracy and lesion conspicuity compared to T2* for acute venous clot detection near the skull base.