Evaluating hemorrhagic risks using intratumoral susceptibility signals in stereotactic brain biopsies

Stereotactic brain biopsy is a crucial diagnostic tool for brain lesions; however, post-biopsy hemorrhage remains a significant complication. Recent studies have indicated that the intratumoral susceptibility signal (ITSS) grading derived from susceptibility-weighted imaging (SWI) may function as a predictor of hemorrhagic risk. To evaluate the predictive value of ITSS grading for post-biopsy hemorrhage and associated complications, and to identify variables associated with high ITSS grades. This retrospective study included 200 patients who underwent stereotactic brain biopsies between April 2019 and September 2021. ITSS grading was conducted using preoperative SWI, and post-biopsy hemorrhages were evaluated using CT. Multivariate analyses were performed to ascertain the association between the ITSS grade and complications. Post-biopsy hemorrhage occurred in 24% of the patients, with 14.5% exhibiting hemorrhage > 10 mm in diameter. High ITSS grades (grades 2 and 3) were observed in 45% of the patient population, and were significantly associated with larger lesions, glioblastomas, IDH-wildtype, and contrast enhancement. Symptomatic complications occurred in 9 biopsies (4.5%). A high ITSS grade was an independent predictor of significant hemorrhage (OR 3.2, _95%CI [1.4-7.5], p = 0.007). Furthermore, brainstem localization and high ITSS grade were independently associated with symptomatic complications. ITSS grading serves as a valuable tool for stratifying hemorrhagic risk in stereotactic brain biopsies. High ITSS grades could indicate the necessity for enhanced monitoring, whereas low grades suggest suitability for outpatient procedures. Further multicenter studies are required to validate these findings and explore advanced imaging integrations. Clinical trial number Not applicable.