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. 2024 Jun 3;16(6):e61591.
doi: 10.7759/cureus.61591. eCollection 2024 Jun.

Diagnostic Algorithm for Intracranial Lesions in the Emergency Department: Effectiveness of the Relative Brain Volume and Hounsfield Unit Value Measured by Perfusion Tomography

Juan Antonio Alvaro-Heredia  1   2 , Luis A Rodríguez-Hernández  1 , Héctor A Rodríguez-Rubio  1 , Isidro Alvaro-Heredia  3 , Michel G Mondragon-Soto  1 , Ivan A Rodríguez-Hernández  1 , Edgardo de Jesus Mateo-Nouel  1 , Eliezer Villanueva-Castro  1 , Rodrigo Uribe-Pacheco  1 , Elvira Castro-Martinez  3 , Guillermo A Gutierrez-Aceves  4 , Sergio Moreno-Jiménez  5   4 , Ignacio Reyes-Moreno  6 , Alberto Gonzalez-Aguilar  6
Affiliations

Diagnostic Algorithm for Intracranial Lesions in the Emergency Department: Effectiveness of the Relative Brain Volume and Hounsfield Unit Value Measured by Perfusion Tomography

Juan Antonio Alvaro-Heredia et al. Cureus. .

Abstract

Background Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility. Purpose This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions. Methods A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions. Results We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%). Conclusion PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.

Keywords: abscesses; ct perfusion; glioblastoma; intracranial brain tumors; lymphoma; metastasis; perfusion parameters.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. National Institute of Neurology and Neurosurgery issued approval 43-22. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PCT/CT images, HU, and color maps in four different histologically proven lesions: (A) PCNSL, (B) abscess, (C) METs, and (D) GB.
PCT/CT: perfusion computed tomography/computed tomography, PCNSL: primary central nervous system lymphoma, METs: metastases, GB: glioblastoma
Figure 2
Figure 2. Flow diagram proposed in the present study (the patient on the top undergos several nodes to discriminate intracerebral lesions).
rCBV: relative cerebral blood volume; HU: Hounsfield unit
See this image and copyright information in PMC

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