{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T03:40:04Z","timestamp":1750390804426,"version":"3.41.0"},"reference-count":45,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001843","name":"Science and Engineering Research Board","doi-asserted-by":"publisher","award":["CRG\/2019\/005032"],"award-info":[{"award-number":["CRG\/2019\/005032"]}],"id":[{"id":"10.13039\/501100001843","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Isocitrate dehydrogenase (IDH) wild\u2010type (IDH<jats:sub>wt<\/jats:sub>) glioblastomas (GB) are more aggressive and have a poorer prognosis than IDH mutant (IDH<jats:sub>mt<\/jats:sub>) tumors, emphasizing the need for accurate preoperative differentiation. However, a distinct imaging biomarker for differentiation mostly lacking. Intratumoral thrombosis has been reported as a histopathological biomarker for GB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the fragmented intratumoral thrombosed microvasculature (FTV) signs on susceptibility\u2010weighted imaging (SWI) for distinguishing IDH<jats:sub>wt<\/jats:sub> and IDH<jats:sub>mt<\/jats:sub> tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Retrospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects<\/jats:title><jats:p>Ninety\u2010seven treatment\u2010na\u00efve patients with histopathologically confirmed IDH<jats:sub>wt<\/jats:sub> GB (54 males, 26 females) and IDH<jats:sub>mt<\/jats:sub> grade 4 astrocytoma (13 males, 4 females).<\/jats:p><\/jats:sec><jats:sec><jats:title>Field Strength\/Sequence<\/jats:title><jats:p>3\u2010T, SWI, fluid\u2010attenuated\u2010inversion\u2010recovery (FLAIR), T<jats:sub>1<\/jats:sub>\u2010weighted, T<jats:sub>2<\/jats:sub>\u2010weighted, PD\u2010weighted, post\u2010contrast T<jats:sub>1<\/jats:sub>\u2010weighted and dynamic\u2010contrast\u2010enhanced (DCE)\u2010MRI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>SWI data were evaluated by three experienced neuroradiologists (S.S., 11\u2009years; J.S., 15\u2009years; R.K.G., 40\u2009years of experience), who assessed FTV presence in necrotic and peri\u2010necrotic regions. FTV was identified as intratumoral susceptibility signal having minimal or no interslice connections. Quantitative DCE\u2010MRI parameters were derived using first\u2010pass\u2010analysis and extended Tofts model. FLAIR abnormal, contrast\u2010enhancing, and necrotic regions were segmented using in\u2010house developed U\u2010Net architecture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>Fleiss' Kappa, Cohen's Kappa, Shapiro\u2013Wilk test, <jats:italic>t<\/jats:italic> tests or Mann\u2013Whitney <jats:italic>U<\/jats:italic> test, receiver\u2010operating characteristic (ROC) analysis, confusion matrix. A <jats:italic>P<\/jats:italic>\u2010value &lt;0.05 was considered statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fleiss' kappa test provided 91% inter\u2010rater agreement, and Cohen's kappa provided intrarater agreement ranged from 81% to 97%. The raters' accuracy in distinguishing IDH<jats:sub>wt<\/jats:sub> from IDH<jats:sub>mt<\/jats:sub> ranged from 92% to 94%. Some of the quantitative DCE\u2010MRI parameters (CBV, Ve, and K<jats:sup>trans<\/jats:sup>) provided statistically significant differences in differentiating IDH<jats:sub>wt<\/jats:sub> and IDH<jats:sub>mt<\/jats:sub>. K<jats:sup>trans<\/jats:sup> demonstrated 80.3% sensitivity and 81.2% specificity, with ROC analysis showing an AUC of 0.77.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Conclusion<\/jats:title><jats:p>FTV signs in necrotic and peri\u2010necrotic regions on SWI demonstrated a high accuracy in distinguishing IDH<jats:sub>wt<\/jats:sub> from IDH<jats:sub>mt<\/jats:sub>. Qualitative assessment of FTV signs showed almost perfect inter\u2010rater and intrarater agreement. Quantitative DCE\u2010MRI metrics also showed statistically significant differentiation of IDH<jats:sub>wt<\/jats:sub> and IDH<jats:sub>mt<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:p>This study demonstrates that preoperative imaging, particularly the visualization of the fragmented thrombosed vasculature (FTV) sign on susceptibility\u2010weighted imaging (SWI), effectively differentiates isocitrate dehydrogenase (IDH) wild\u2010type (IDH<jats:sub>wt<\/jats:sub>) glioblastoma (GB) from IDH mutant (IDH<jats:sub>mt<\/jats:sub>) grade 4 astrocytomas. Over 90% of IDH<jats:sub>wt<\/jats:sub> GB patients displayed the FTV sign, a specific imaging biomarker absent in IDH<jats:sub>mt<\/jats:sub> cases. Perfusion parameters such as cerebral blood volume, Ve, and K<jats:sup>trans<\/jats:sup> were elevated in IDH<jats:sub>wt<\/jats:sub> gliomas, reflecting distinct vascular profiles. SWI offers a noninvasive and accurate diagnostic method, overcoming limitations of histopathology. Despite limitations like unequal sample sizes and retrospective analysis, this study underscores the clinical potential of SWI in improving glioma characterization and aiding treatment planning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4<\/jats:p><\/jats:sec><jats:sec><jats:title>Technical Efficacy<\/jats:title><jats:p>Stage 2<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.29695","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T09:40:15Z","timestamp":1736415615000},"page":"258-270","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Presence of Fragmented Intratumoral Thrombosed Microvasculature in the Necrotic and Peri\u2010Necrotic Regions on <scp>SWI<\/scp> Differentiates <scp>IDH<\/scp> Wild\u2010Type Glioblastoma From <scp>IDH<\/scp> Mutant Grade 4 Astrocytoma"],"prefix":"10.1002","volume":"62","author":[{"given":"Virendra Kumar","family":"Yadav","sequence":"first","affiliation":[{"name":"Centre for Biomedical Engineering Indian Institute of Technology Delhi  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shalini","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Radiology Fortis Memorial Research Institute  Gurugram India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satyajit","family":"Maurya","sequence":"additional","affiliation":[{"name":"Centre for Biomedical Engineering Indian Institute of Technology Delhi  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakesh K.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Radiology Fortis Memorial Research Institute  Gurugram India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5218-0264","authenticated-orcid":false,"given":"Jitendra","family":"Saini","sequence":"additional","affiliation":[{"name":"Department of the Neuroimaging and Interventional Radiology NIMHANS  Bengaluru India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Preeti","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Pathology Agilus\u2014Fortis Memorial Research Institute  Gurugram India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rana","family":"Patir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Fortis Memorial Research Institute  Gurugram India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunita","family":"Ahlawat","sequence":"additional","affiliation":[{"name":"Department of Pathology Agilus\u2014Fortis Memorial Research Institute  Gurugram India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumanta","family":"Das","sequence":"additional","affiliation":[{"name":"Department of the Neuroimaging and Interventional Radiology NIMHANS  Bengaluru India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Vaishya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Fortis Memorial Research Institute  Gurugram India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumeet","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering Indian Institute of Technology Delhi  New Delhi India"},{"name":"Yardi School of Artificial Intelligence Indian Institute of Technology Delhi  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6744-8326","authenticated-orcid":false,"given":"Anup","family":"Singh","sequence":"additional","affiliation":[{"name":"Centre for Biomedical Engineering Indian Institute of Technology Delhi  New Delhi India"},{"name":"Yardi School of Artificial Intelligence Indian Institute of Technology Delhi  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6047-3115","authenticated-orcid":false,"given":"Rakesh K.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Radiology Fortis Memorial Research Institute  Gurugram India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2018.07.018"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/JMRI.26704"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00234-021-02636-8\/METRICS"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/NBM.4884"},{"key":"e_1_2_7_6_1","unstructured":"OncoLink.Adult glioma: Grading and treatment. 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