CT-perfusion in assessment of the malignant gliomas hemodynamics

Aim. To study the role of CT perfusion in the differential diagnosis of histological subtypes of supratentorial malignant gliomas and to determine the degree of their malignancy.

Materials and methods. The study included 34 patients (20 men and 14 women, with an average age of 52 years) with newly detected supratenorial glial tumors, who subsequently underwent neurosurgical treatment in the NMIC of neurosurgery with histological verification of the diagnosis. Depending on the histological diagnosis, three groups of patients were identified: 1) anaplastic astrocytomas, 2) glioblastomas, 3) anaplastic oligodendrogliomas.
The CT-perfusion protocol was performed on a 64-slice Optima 660 (GE) scanner and consisted of three separate parts: a low-dose axial CT of the brain with a slice thickness of 5 mm (90 kV), a perfusion protocol performed according to a prolonged scheme, with two consecutive continuous series of scans, and a post-contrast series of CT images in a spiral scanning mode. In addition, all patients underwent an MRI examination (using a Signa Hdxt 3.0 T (GE) MR scanner, in T2, T2-FLAIR, SWAN, DWI, and T1 modes before and after contrast enhancement).

Results. The study demonstrated that anaplastic astrocytomas are characterized by significantly low absolute and normalized hemodynamics parameters (BF, BV, PS) when compared with glioblastomas, and significantly low absolute maximum values of blood flow (BF) and blood volume (BV) when compared with the group of anaplastic oligodendrogliomas. CT perfusion using the normalized permeability index (PS) can reliably differentiate glioblastomas and anaplastic oligodendrogliomas. Perfusion parameters, both absolute and normalized, did not show statistically significant differences in the differential diagnosis of various molecular and genetic subtypes of anaplastic astrocytomas.

Conclusion. CT perfusion using all hemodynamic parameters demonstrated high reliability and efficacy in distinguishing between glioblastomas and anaplastic astrocytomas. Further research is required to evaluate the effectiveness of the method in distinguishing glioblastomas from anaplastic oligodendrogliomas.

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