Brain volume perfusion CT performed with 128-detector row CT system in patients with cerebral gliomas: A feasibility study

Abstract

ObjectivesValidation of the feasibility and efficacy of volume perfusion computed tomography (VPCT) in the preoperative assessment of cerebral gliomas by applying a 128-slice CT covering the entire tumour.MethodsForty-six patients (25 men, 21 women; mean age 52.8 years) with cerebral gliomas were evaluated with VPCT. Two readers independently evaluated VPCT data, drawing volumes of interest (VOIs) around the tumour according to maximum intensity projection volumes, which were mapped automatically onto the cerebral blood volume (CBV), flow (CBF) and permeability (Ktrans) perfusion datasets. As control, a second VOI was placed in the contralateral healthy cortex. Correlation among perfusion parameters, tumour grade, hemisphere and VOIs was assessed. The diagnostic power of perfusion parameters was analysed by receiver operating characteristics curve analyses.ResultsVPCT was feasible in the assessment of the entire tumour extent. Mean values of Ktrans, CBV, CBF in high-grade gliomas were significantly higher compared with low-grade (p < 0.01). Ktrans demonstrated the highest diagnostic (97% sensitivity), positive (100%) and negative (94%) prognostic values.ConclusionsVPCT was feasible in all subjects. All areas of different perfusion characteristics are depicted and quantified in colour-coded 3D maps. The derived parameters correlate well with tumour histopathology, differentiating low- from high-grade gliomas.

Dynamic perfusion CT in brain tumors

“…In general, PCT of HGGs (grade III and IV) demonstrated higher BF, BV, and PS than low-grade gliomas (grade II) [11,[14][15][16][17][18][19][20][21][22]. Figs.…”

Perfusion computed tomography of intracranial meningiomas: In vivo correlation of cerebral blood volume and vascular permeability

“…The distribution of the contrast medium following injection is determined by the microvascularization and the diffusion across the endothelial membrane. [10][11][12] Regional cerebral blood volume (rCBV) reflects an assessment of tumour vasculature and perfusion and it can be considered as a good surrogate marker for MVD, revealing information about the total amount of vessels in the tumour including neovessels and the native vasculature. Permeability surface-area (PS) product indicates the diffusion of contrast agent moving from the blood vessels into the interstitial space caused by tumour-induced blood-brain barrier (BBB) disruption.…”

“…The technique provides high spatial resolution and it represents a valid alternative for the assessment of cerebral haemodynamics. 11,12,13,29 PCT is performed by monitoring the first passage of an iodinated contrast agent bolus through the brain vessels. Conceptually, the contrast-medium pharmacokinetic involves three brain compartments: intracellular, intravascular and interstitial.…”

Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage

“…18,30 Computed tomography perfusion (CTP) allows visualization of brain perfusion and has been applied in brain tumors, ischemic stroke, and aSAH. 1,4,10,12,14,15,[17][18][19]23,25,28,33,[36][37][38] A disadvantage of CTP is the exposure to radiation, which precludes its frequent use. This is reflected by available studies, in which CTP was performed once between Days 5 and 14, which represent the days with the highest probability of vasospasm occurrence.…”

“…4,12,15,17,18,23,29,35,36 Recently, whole-brain CTP became available, which might at least overcome the problem of focal perfusion measurement. 10,25,37,38 The aim of this prospective study was to evaluate the role of whole-brain CTP for the identification of tissue at risk for DCI and, thereby, of patients at risk for developing DIND and/or vasospasm-associated infarction, either 1) early after aSAH, prior to the vasospasm period; 2) during rapidly progressive TCD-confirmed vasospasm with or without symptoms; and/or 3) on Day 7 in patients who were comatose or sedated and could not be neurologically assessed.…”