Serial stereotactic biopsies and CT scan in gliomas: correlative study in 100 astrocytomas,oligo-astrocytomas and oligodendrocytomas

Histologic features of 100 supra-tentorial astrocytomas, oligodendrogliomas and oligo-astrocytomas obtained from serial stereotactic biopsies were compared with the corresponding CT scans. Topographic comparisons provided by visualization of the biopsy trajectories on post-biopsy CT scans were available in 24 cases. Areas of contrast enhancement and low attenuation were compared with the histologic grade of malignancy, tumor delimitation and structural type. The latter was determined as follows: Type I-solid tumor tissue without significant peripheral isolated tumor cells; Type II-solid tumor tissue associated with peripheral isolated tumor cells; Type III-isolated tumor cells only.There was a strong correlation between areas of contrast enhancement and tumor microvascularity. In addition, contrast enhancement occurred only in the solid tumor tissue component of the neoplasm. This correlation accounted for the relationship observed between CT images and the structural type of glioma. Contrast enhancement was constant in structural type I gliomas, inconstant in structural type II, and absent in structural type III. No correlation was found between malignancy and contrast enhancement. Contrast enhancement occurred in all grades of malignancy but was a constant feature of grade 4 gliomas. The volume of the tumors could not be reliably determined from CT images alone. Areas of low attenuation on contrast CT scans could correspond to either peritumoral edema or to edematous parenchyma infiltrated by isolated tumor cells.Serial stereotactic biopsies combined with calculations based on the CT scan provided a more precise definition of the tumor volume and identification of structural type. Such classification may prove useful in prospective analysis of various modes of therapy.