Mortensen Sharri Junadi, Bjerrum Shima Naebi, Hedegaard Stine Frost, Tietze Anna, Gottrup Hanne, von Oettingen Gorm
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Acta Neurochir (Wien). 2018 Apr;160(4):667-672. doi: 10.1007/s00701-018-3478-z. Epub 2018 Feb 5.
To improve the quality of care for brain cancer patients, the Danish Ministry of Health has set standards for the diagnosis and treatment. When a patient is suspected of having a malignant tumour involving the brain, it is required that a magnetic resonance imaging of the cerebrum (MRI-C) be obtained within seven calendar days of referral from a primary care provider. This standard has the potential to consume MR imaging time that might otherwise be used for evaluation or treatment monitoring of other patients. This study primarily aims to assess the sensitivity of computed tomography of the brain (CT-C) for the detection of intracranial tumour as the initial diagnostic imaging.
This is a single-center retrospective study of patients referred to the IBCP with brain cancer suspicion. The average follow-up was 37 months. All included patients underwent a CT-C scan and subsequently a MRI-C if deemed necessary. The study population was divided into two groups based on the findings: tumour versus non-tumour. Sensitivity and specificity of the CT-C was calculated.
Eight hundred seventeen patients were included. Median age was 55 years and 50% were male. CT-C had a sensitivity of 98.5% and a specificity of 98.4%. The overall mortality rate was 7% in the non-tumour group and 58% in the tumour group over the course of the study period. The tumour group was on average older compared to the non-tumour group (65 years [55-75 years] vs 52 years [38-65 years]) p < .001). The only symptom associated with brain tumour was the presence of a focal deficit (p = .002).
This study shows that CT-C scans are highly sensitive and specific and can be used as the primary screening tool for patients referred with a suspicion for brain cancer.
为提高脑癌患者的护理质量，丹麦卫生部制定了诊断和治疗标准。当怀疑患者患有累及脑部的恶性肿瘤时，要求在初级保健提供者转诊后的七个日历日内进行大脑磁共振成像（MRI-C）检查。该标准可能会占用磁共振成像时间，而这些时间原本可用于其他患者的评估或治疗监测。本研究主要旨在评估脑部计算机断层扫描（CT-C）作为初始诊断成像检测颅内肿瘤的敏感性。
这是一项对转诊至国际脑癌中心且疑似患有脑癌的患者进行的单中心回顾性研究。平均随访时间为37个月。所有纳入的患者均接受了CT-C扫描，如有必要随后还接受了MRI-C检查。根据检查结果将研究人群分为两组：肿瘤组和非肿瘤组。计算CT-C的敏感性和特异性。
共纳入817例患者。中位年龄为55岁，50%为男性。CT-C的敏感性为98.5%，特异性为98.4%。在研究期间，非肿瘤组的总死亡率为7%，肿瘤组为58%。与非肿瘤组相比，肿瘤组患者平均年龄更大（65岁[55 - 75岁]对52岁[38 - 65岁]，p < 0.001）。与脑肿瘤相关的唯一症状是存在局灶性神经功能缺损（p = 0.002）。
本研究表明，CT-C扫描具有高度的敏感性和特异性，可作为疑似脑癌转诊患者的主要筛查工具。
