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Identifier 000381115
Title Μελέτη και αξιολόγηση των παραμέτρων της περιοχικής αιματικής διήθησης (Perfusion) του εγκεφάλου, με χρήση πολυτομικού αξονικού τομογράφου 128 τόμων , σε ασθενείς με ενδοεγκεφαλικά νεοπλάσματα
Alternative Title Assessement of brain perfusiin in patients with cerebral gliomas the application of multi-detector 128 slices CT
Author Ξύδα, Αργυρώ Απ
Thesis advisor Καραντάνας, Απόστολος
Reviewer Μαυρουδής, Δημήτριος
Βάκης, Αντώνιος
Περυσινάκης, Κωνσταντίνος
Παπαδάκη, Εφροσύνη
Μαρής, Θωμάς
Καρκαβίτσας, Νικόλαος
Abstract Aim: The aim of our study was to evaluate the preoperative diagnostic power and classification accuracy of perfusion parameters derived from whole brain volume perfusion CT (VPCT) in patients with cerebral tumours. Materials & Methods: Sixty‐three consecutive patients, with MRI findings suggestive of cerebral lesions, were recruited prospectively in our series (31 male, 32 female; mean age 55.6 ± 13.9 years). All patients underwent VPCT. VPCT was carried out by using a 128 slice‐4D‐spiral CT scanner with a constant bidirectional movement of the patient table. None of them has been treated either with biopsy or surgery prior to study. Two readers independently evaluated VPCT data. Volumes of interest (VOIs) were marked circumscript around the tumour according to maximum intensity projection volumes, and then mapped automatically onto the cerebral blood volume (CBV), flow (CBF) and permeability (Ktrans) perfusion datasets. A second VOI, cortically pronounced, was placed in the contra lateral hemisphere in order to obtain control values. Statistical analysis followed and correlations among perfusion values, tumour grade, cerebral hemisphere and VOIs were evaluated. Moreover, the diagnostic power of VPCT parameters, by means of positive and negative predictive value, was analysed by Receiver Operating Characteristic curve analysis. Results: Histopathological analysis revealed 32 high‐grade gliomas WHO III/IV, 18 low‐grade I/II, 6 primary cerebral lymphomas, 4 metastases and 3 tumour‐like lesions. Our data analysis showed that high‐grade gliomas could be differentiated from low‐grade gliomas due to the significant elevation in all the three perfusion parameters. Lymphomas could be differentiated from low‐grade gliomas according 82 to the remarkable increase in Ktrans, a finding, which is in keeping with the histopathologic feature of blood‐brain barrier disturbance in lymphomas. Finally, high‐grade gliomas proved to have significantly higher CBF and CBV values when compared to lymphomas, probably due to neovascularisation. Primary cerebral lymphomas though, presented with significantly higher Ktrans. Our results imply that high‐grade gliomas are also characterised by blood‐brain barrier disruption, but to a lesser grade than lymphomas. Ktrans proved to be the perfusion parameter with the highest sensitivity, specificity and positive predictive value, for the pair‐wise comparison between high‐grade and low‐grade gliomas. Finally, for the differentiation between high‐grade and primary cerebral lymphomas, CBF and CBV demonstrated the highest specificity and positive predictive value, identifying preoperatively all the histopathologically proven high‐grade gliomas. Their NPV, though, was much lower than that of Ktrans. 96% of the lesions with Ktrans value less than 6.48mL/100mL/min proved to be high‐grade on histopathology. Conclusion: As a conclusion, our data suggest that all the three perfusion parameters play an important role in the preoperative classification of cerebral tumour entities demonstrating a high rate of histopathologic correlation.
Language Greek
Subject Gliomas
Multi-detector row CT
Primary cerebral lymphomas
Περιοχική αιματική διήθηση
Πολυτομικός αξονικός τομογράφος
Πρωτοπαθές εγκεφαλικό λέμφωμα
Issue date 2013-06-12
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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