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. 2022 Oct 15;12(10):2494.
doi: 10.3390/diagnostics12102494.

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

Jan Borggrefe  1 , Max Philipp Gebest  2 , Myriam Hauger  3 , Daniel Ruess  4 , Anastasios Mpotsaris  5 , Christoph Kabbasch  3 , Lenhard Pennig  3 , Kai Roman Laukamp  3 , Lukas Goertz  3 , Jan Robert Kroeger  1 , Jonas Doerner  3
Affiliations

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

Jan Borggrefe et al. Diagnostics (Basel). .

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.

Keywords: dual-energy computed tomography; iodine quantification; neurooncology; tumor differentiation.

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Conflict of interest statement

J.B., J.D., L.P., K.R.L. and J.R.K.: Speaker buro for Siemens Healthcare/Philips Healthcare. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Iodine map of dual layer computed tomography showing a contrast-enhancing glioblastoma (WHO IV) located in the left-sided temporooccipital gyrus.
Figure 2
Figure 2
(a,b): Differentiation of tumor entity based on density measures and CNR of contrast enhancement in conventional polyenergetic reconstructions of DLCT (Figure 1a) and DLCT iodine maps. In contrast to simple density measures, CNR allows for improved differentiation between the prevalent tumor entities (compare data listed in Table 1). Lymphoma showed the highest CNR, significantly higher than the second strongest enhancing tumor entities glioblastoma and brain metastases which did not show a significant difference in tumor density. The astrocytomas WHO II and WHO III as well as oligodendrogliomas showed a significantly lower CNR than lymphomas, glioblastomas and metastases.
Figure 3
Figure 3
In the subset of 78 gliomas, CNR was significantly higher in IDH 1 wild-type gliomas than in gliomas with IDH 1 mutation, both in conventional polyenergetic CT (2.19 ± 1.33 vs. 1.39 ± 1.4, p = 0.004) and iodine density mapping (2.22 ± 1.53 vs. 1.60 ± 1.78, p = 0.03). MGMT methylated gliomas showed a lower density in comparison to MGMT unmethylated gliomas which was however not significant (p = 0.11–0.22).
Figure 4
Figure 4
There was a significantly higher tumor density in women (62.2 ± 22.1 HU) in comparison to men (54.9 ± 19.9 HU, p = 0.04).
Figure 5
Figure 5
There was no significant correlation between tumor density and patient (a) age (r2 = 0.02, ns); (b) weight (r2 = 0.02, ns).
See this image and copyright information in PMC

References

    1. Cha S. Neuroimaging in neuro-oncology. Neurotherapeutics. 2009;6:465–477. doi: 10.1016/j.nurt.2009.05.002. - DOI - PMC - PubMed
    1. Burger P.C., Vogel F.S., Green S.B., Strike T.A. Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer. 1985;56:1106–1111. doi: 10.1002/1097-0142(19850901)56:5<1106::AID-CNCR2820560525>3.0.CO;2-2. - DOI - PubMed
    1. Okunieff P., Fenton B.M., Zhang L., Kern F.G., Wu T., Greg J.R., Ding I. Fibroblast Growth Factors (FGFS) Increase Breast Tumor Growth Rate, Metastases, Blood Flow, and Oxygenation Without Significant Change in Vascular Density. Adv. Exp. Med. Biol. 2003;530:593–601. doi: 10.1007/978-1-4615-0075-9_58. - DOI - PubMed
    1. Fenton B.M., Paoni S.F. Oxygenation and vascular perfusion in spontaneous and transplanted tumor models. Adv. Exp. Med. Biol. 2003;530:165–176. doi: 10.1007/978-1-4615-0075-9_16. - DOI - PubMed
    1. Reifenberger G., Wirsching H.G., Knobbe-Thomsen C.B., Weller M. Advances in the molecular genetics of gliomas—Implications for classification and therapy. Nat. Rev. Clin. Oncol. 2017;14:434–452. doi: 10.1038/nrclinonc.2016.204. - DOI - PubMed