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; Luis A Rodríguez-Hernández; Héctor A Rodríguez-Rubio; Isidro Alvaro-Heredia; Michel G Mondragon-Soto; Ivan A Rodríguez-Hernández; Edgardo de Jesus Mateo-Nouel; Eliezer Villanueva-Castro; Rodrigo Uribe-Pacheco; Elvira Castro-Martinez; Guillermo A Gutierrez-Aceves; Sergio Moreno-Jiménez; Ignacio Reyes-Moreno; Alberto Gonzalez-Aguilar

doi:10.7759/cureus.61591

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

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

Authors

Juan Antonio Alvaro-Heredia^{1

2}, Luis A Rodríguez-Hernández¹, Héctor A Rodríguez-Rubio¹, Isidro Alvaro-Heredia³, Michel G Mondragon-Soto¹, Ivan A Rodríguez-Hernández¹, Edgardo de Jesus Mateo-Nouel¹, Eliezer Villanueva-Castro¹, Rodrigo Uribe-Pacheco¹, Elvira Castro-Martinez³, Guillermo A Gutierrez-Aceves⁴, Sergio Moreno-Jiménez^{5

4}, Ignacio Reyes-Moreno⁶, Alberto Gonzalez-Aguilar⁶

Affiliations

¹ Neurological Surgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
² Spine Surgery, National Institute of Rehabilitation, Mexico City, MEX.
³ Emergency Medicine, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
⁴ Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
⁵ Neurosurgery-Radiosurgery, The American British Cowdray (ABC) Medical Center, Mexico City, MEX.
⁶ Neuro-Oncology, The American British Cowdray (ABC) Medical Center, Mexico City, MEX.

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.