Differentiation of Intracerebral Tumor Entities with Quantitative Contrast Attenuation and Iodine Mapping in Dual-Layer Computed Tomography

Abstract

Purpose: To investigate if quantitative contrast enhancement and iodine mapping of common brain tumor (BT) entities may correctly differentiate between tumor etiologies in standardized stereotactic CT protocols. Material and Methods: A retrospective monocentric study of 139 consecutive standardized dual-layer dual-energy CT (dlDECT) scans conducted prior to the stereotactic needle biopsy of untreated primary brain tumor lesions. Attenuation of contrast-enhancing BT was derived from polyenergetic images as well as spectral iodine density maps (IDM) and their contrast-to-noise-ratios (CNR) were determined using ROI measures in contrast-enhancing BT and healthy contralateral white matter. The measures were correlated to histopathology regarding tumor entity, isocitrate dehydrogenase (IDH) and MGMT mutation status. Results: The cohort included 52 female and 76 male patients, mean age of 59.4 (±17.1) years. Brain lymphomas showed the highest attenuation (IDM CNR 3.28 ± 1,23), significantly higher than glioblastoma (2.37 ± 1.55, p < 0.005) and metastases (1.95 ± 1.14, p < 0.02), while the differences between glioblastomas and metastases were not significant. These strongly enhancing lesions differed from oligodendroglioma and astrocytoma (Grade II and III) that showed IDM CNR in the range of 1.22–1.27 (±0.45–0.82). Conventional attenuation measurements in DLCT data performed equally or slightly superior to iodine density measurements. Conclusion: Quantitative attenuation and iodine density measurements of contrast-enhancing brain tumors are feasible imaging biomarkers for the discrimination of cerebral tumor lesions but not specifically for single tumor entities. CNR based on simple HU measurements performed equally or slightly superior to iodine quantification.

Smart Visualization of Medical Images as a Tool in the Function of Education in Neuroradiology

“…This includes the inability to use iodine contrast media in pre-existing and confirmed allergic reactions, which consequently refers the patient to MRI diagnostics that are not available to everyone because they have both absolute and relative contraindications. With the goal of successful treatment and diagnosis of brain diseases in patients, current research in MDCT and MRI diagnostics aims to characterize brain diseases non-invasively [ 42 , 43 , 44 , 45 , 46 ]. However, multi-detector computed tomography has some advantages concerning MRI diagnostics, enabling quantitative measures of deterioration of the blood–brain barrier that may be associated with tumor and neovascularization [ 42 , 43 , 47 , 48 ].…”

“…With the goal of successful treatment and diagnosis of brain diseases in patients, current research in MDCT and MRI diagnostics aims to characterize brain diseases non-invasively [ 42 , 43 , 44 , 45 , 46 ]. However, multi-detector computed tomography has some advantages concerning MRI diagnostics, enabling quantitative measures of deterioration of the blood–brain barrier that may be associated with tumor and neovascularization [ 42 , 43 , 47 , 48 ].…”

“…With the goal of successful treatment and diagnosis of brain diseases in patients, current research in MDCT and MRI diagnostics aims to characterize brain diseases non-invasively [42][43][44][45][46]. However, multi-detector computed tomography has some advantages concerning MRI diagnostics, enabling quantitative measures of deterioration of the blood-brain barrier that may be associated with tumor and neovascularization [42,43,47,48]. Due to the stated conditions and limitations in Figure 1b at Step 4, in order to prevent post-contrast scanning of the patient, a New Step 4 in Figure 1c is proposed which enables the smart visualization of medical images (SVMI) and a more precise presentation to neurologists of the localized changes in the patient's brain at a determined cross-section of plane and slice.…”