Susceptibility weighted imaging and mapping of micro-hemorrhages and major deep veins after traumatic brain injury

Micro-hemorrhages are a common result of traumatic brain injury (TBI), which can be quantified with susceptibility weighted imaging and mapping (SWIM), a quantitative susceptibility mapping approach. A total of 23 TBI patients (five women, 18 men; median age, 41.25 years old; range, 21.69-67.75 years) with an average Glasgow Coma Scale score of 7 (range, 3-15) at admission were recruited at mean 149 d (range, 57-366) after injury. Susceptibility-weighted imaging data were collected and post-processed to create SWIM images. The susceptibility value of small hemorrhages (diameter ≤10 mm) and major deep veins (right septal, left septal, central septal, right thalamostriate, left thalamostriate, internal cerebral, right basal vein of Rosenthal, left basal vein of Rosenthal, and pial veins) were evaluated. Different susceptibility thresholds were tested to determine SWIM's sensitivity and specificity for differentiating hemorrhages from the veins. A total of 253 deep veins and 173 small hemorrhages were identified and evaluated. The mean susceptibility of hemorrhages was 435±206 parts per billion (ppb) and the mean susceptibility of deep veins was 108±56 ppb. Hemorrhages showed a significantly higher susceptibility than all deep veins (p<0.001). With different thresholds (250, 227 and 200 ppb), the specificity was 97%, 95%, and 92%, and the sensitivity was 84%, 90%, and 92%, respectively. These results show that SWIM could be used to differentiate hemorrhages from veins in TBI patients in a semi-automated manner with reasonable sensitivity and specificity. A larger cohort will be needed to validate these findings.