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. 2020 Jan 16;20(1):5.
doi: 10.1186/s12880-019-0406-5.

Dual-energy spectral CT quantitative parameters for the differentiation of Glioma recurrence from treatment-related changes: a preliminary study

Yanchun Lv  1 , Jian Zhou  1 , Xiaofei Lv  1 , Li Tian  1 , Haoqiang He  1 , Zhigang Liu  2 , Yi Wu  3 , Lujun Han  1 , Meili Sun  1 , Yadi Yang  1 , Chengcheng Guo  4 , Cong Li  4 , Rong Zhang  1 , Chuanmiao Xie  1 , Yinsheng Chen  5 , Zhongping Chen  6
Affiliations

Dual-energy spectral CT quantitative parameters for the differentiation of Glioma recurrence from treatment-related changes: a preliminary study

Yanchun Lv et al. BMC Med Imaging. .

Abstract

Background: Differentiating glioma recurrence from treatment-related changes can be challenging on conventional imaging. We evaluated the efficacy of quantitative parameters measured by dual-energy spectral computed tomographic (CT) for this differentiation.

Methods: Twenty-eight patients were examined by dual-energy spectral CT. The effective and normalized atomic number (Zeff and Zeff-N, respectively); spectral Hounsfield unit curve (λHU) slope; and iodine and normalized iodine concentration (IC and ICN, respectively) in the post-treatment enhanced areas were calculated. Pathological results or clinicoradiologic follow-up of ≥2 months were used for final diagnosis. Nonparametric and t-tests were used to compare quantitative parameters between glioma recurrence and treatment-related changes. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and accuracy were calculated using receiver operating characteristic (ROC) curves. Predictive probabilities were used to generate ROC curves to determine the diagnostic value.

Results: Examination of pre-contrast λHU, Zeff, Zeff-N, IC, ICN, and venous phase ICN showed no significant differences in quantitative parameters (P > 0.05). Venous phase λHU, Zeff, Zeff-N, and IC in glioma recurrence were higher than in treatment-related changes (P < 0.001). The optimal venous phase threshold was 1.03, 7.75, 1.04, and 2.85 mg/cm3, achieving 66.7, 91.7, 83.3, and 91.7% sensitivity; 100.0, 77.8, 88.9, and 77.8% specificity; 100.0, 73.3, 83.3, and 73.3% PPV; 81.8, 93.3, 88.9, and 93.3% NPV; and 86.7, 83.3, 86.7, and 83.3% accuracy, respectively. The respective areas under the curve (AUCs) were 0.912, 0.912, 0.931, and 0.910 in glioma recurrence and treatment-related changes.

Conclusions: Glioma recurrence could be potentially differentiated from treatment-related changes based on quantitative values measured by dual-energy spectral CT imaging.

Keywords: Dual energy spectral CT; Glioma; Recurrence.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced venous phase GSI images show that IC and spectral curve were significantly different in glioma recurrence and the normal reference brain parenchyma. a Contrast-enhanced 70-keV monochromatic image (L1: area, 54.16 mm2; mean CT value, 69.33 HU; L2: 54.16 mm2; mean CT value, 48.06 HU). b Iodine-based materialdecomposition. image shows that IC in glioma recurrence and the normal reference brain parenchyma were 0.915 mg/cm3. and 0.113 mg/cm3 (L1: area, 54.16 mm2; mean IC, 9.15 · 100 μg/cm3; L2: area, 54.16 mm2; mean IC, 1.13 · 100 μg/cm3). c Graph shows spectral HU curve of glioma recurrence (yellow) and the normal reference brain parenchyma (red), slope of the curve representing glioma recurrence is much higher than the normal reference brain parenchyma (1.75 vs. 0.20). d The pathology noted after the first operation indicated astrocytoma (Grade II). e A large of tumor cells showed diffused distribution in the smear; eosinophil, nuclear were marked atypia, and the pathologic diagnosis was glioblastoma (Grade IV). f The GFAP was positive
Fig. 2
Fig. 2
Contrast-enhanced venous phase GSI images show that IC and spectral curve were similar in treatment related necrosis and the normal reference brain parenchyma. a Contrast-enhanced 70-keV monochromatic image (L1: area, 105.34 mm2; mean CT value, 45.01 HU; L2: 105.34 mm2; mean CT value, 46.8 HU). b Iodine-based materialdecomposition image shows that IC in glioma recurrence and the normal reference brain parenchyma were 0.031 mg/cm3 and 0.122 mg/cm3 (L1: area, 105.34 mm2; mean IC, 0.31 · 100 μg/cm3; L2: area, 105.34 mm2; mean IC, 1.22 · 100 μg/cm3). c Graph shows spectral HU curve of glioma recurrence (violet) and the normal reference brain parenchyma yellow), slope of the curve representing glioma recurrence is similar with the normal reference brain parenchyma (0.07 vs. 0.22). d The same time with dual energy gemstone spectral CT scanning MRI T1WI enhanced image showed recurrence treatment related necrosis. e Seven months later, the MRI T1WI enhanced image showed the treatment related necrosis was obviously small with slight enhancement
Fig. 3
Fig. 3
Box plots for glioma recurrence and treatment-related changes. The λHU, Zeff-gli, ICgli and Zeff-N measured in glioma recurrence were higher than in treatment-related changes in venous phase
Fig. 4
Fig. 4
Graphs show receiver operating characteristic curves of λHU, Zeff-gli, ICgli and Zeff-N in venous phase for differentiating glioma recurrence from treatment-related changes in patients. The venous Zeff-N had the highest AUC (0.931), with the optimal threshold of 1.04 AUC = area under the curve
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