The Calcium Versus Hemorrhage Trial: Developing Diagnostic Criteria for Chronic Intracranial Susceptibility Lesions Using Single-Energy Computed Tomography, Dual-Energy Computed Tomography, and Quantitative Susceptibility Mapping

Dawid Schellingerhout, Megan Jacobsen, Lucia Le Roux, Jason Johnson, Veera Baladandayuthapani, Ken Ping Hwang, John Hazle, Donald Schomer, Dianna Cody

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose Chronic susceptibility lesions in the brain can be either hemorrhagic (potentially dangerous) or calcific (usually not dangerous) but are difficult to discriminate on routine imaging. We proposed to develop quantitative diagnostic criteria for single-energy computed tomography (SECT), dual-energy computed tomography (DECT), and quantitative susceptibility mapping (QSM) to distinguish hemorrhage from calcium. Materials and Methods Patients with positive susceptibility lesions on routine T2∗-weighted magnetic resonance of the brain were recruited into this prospective imaging clinical trial, under institutional review board approval and with informed consent. The SECT, DECT, and QSM images were obtained, the lesions were identified, and the regions of interest were defined, with the mean values recorded. Criteria for quantitative interpretation were developed on the first 50 patients, and then applied to the next 45 patients. Contingency tables, scatter plots, and McNemar test were applied to compare classifiers. Results There were 95 evaluable patients, divided into a training set of 50 patients (328 lesions) and a validation set of 45 patients (281 lesions). We found the following classifiers to best differentiate hemorrhagic from calcific lesions: less than 68 Hounsfield units for SECT, calcium level of less than 15 mg/mL (material decomposition value) for DECT, and greater than 38 ppb for QSM. There was general mutual agreement among the proposed criteria. The proposed criteria outperformed the current published criteria. Conclusions We provide the updated criteria for the classification of chronic positive susceptibility brain lesions as hemorrhagic versus calcific for each major clinically available imaging modality. These proposed criteria have greater internal consistency than the current criteria and should likely replace it as gold standard.

Original languageEnglish (US)
Pages (from-to)385-393
Number of pages9
JournalInvestigative radiology
Volume56
Issue number6
DOIs
StatePublished - 2021

Keywords

  • calcification
  • dual-energy CT
  • hemorrhage
  • quantitative susceptibility mapping
  • single-energy CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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