Three-dimensional Susceptibility-Weighted Imaging and Two- Dimensional T2*-Weighted Gradient-Echo Imaging of Intratumoral Hemorrhages in Pediatric Diffuse Intrinsic Pontine

Purpose—We compared the sensitivity and specificity of T2*-weighted gradient-echo imaging (T2*-GRE) and susceptibility-weighted imaging (SWI) in determining prevalence and cumulative incidence of intratumoral hemorrhages in children with diffuse intrinsic pontine glioma (DIPG) undergoing anti-angiogenic and radiation therapy. Methods—Patients were recruited from an institutional review board-approved prospective phase I trial of vandetanib administered in combination with radiation therapy. Patient consent was obtained before enrollment. Consecutive T2*-GRE and SWI exams of 17 patients (F/M:9/8; age:3–17 years) were evaluated. Two reviewers (R1 and R2) determined the number and size of hemorrhages at baseline and multiple follow-ups (92 scans, mean 5.4/patient). Statistical analyses were performed using descriptive statistics, graphical tools, and mixed-effects Poisson regression models. Results—Prevalence of hemorrhages at diagnosis was 41 % and 47%; the cumulative incidences of hemorrhages at 6 months by T2*-GRE and SWI were 82 % and 88%, respectively. Hemorrhages were mostly petechial; 9.7 % of lesions on T2*-GRE and 5.2 % on SWI wer