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Role of computed tomography scan in supratentorial mass lesions

Nipa Patidar, Nikhil Shah, Mona Sastri, Ekta Desai, Dhagash Patel, Mona H Chitara, Avni Bhatt.

Abstract
Background: The incidence of tumor, in recent years, increased due to increased longevity and better diagnostic methods. The occurrence of intracranial space occupying lesion (SOL) is relatively higher in younger age group among all tumors. Suspicion and diagnosis of an intracranial SOL amounted to death warrant for lack of knowledge regarding nature and localization.

Objectives: The objective of this study is to study imaging characteristics of brain supratentorial lesions and to compare the radiological findings with histopathology. Furthermore, the aim was to assess the sensitivity, specificity, and positive predictive value for definitive diagnosis of computed tomography (CT) scanning in intracranial SOL.

Materials and Methods: Patients who presented with symptoms of raised intracranial tension (ICT) of subacute onset and had lateralizing sign were investigated by imaging to determine the relative frequency of various mass lesions. The management outcome and follow-up findings were also recorded in the case record form. The imaging findings were correlated with histopathological diagnosis and also with surgical findings. The results were analyzed and studied.

Results: Totally 100 patients with suspected or already diagnosed cases of intracranial SOL were studied by cross-sectional imaging. Children below 20 years of age constituted 40% of cases. Lesions were equally distributed in male and female, i.e., 53% were male and 47% were female. The density of mass lesions shows that 30% lesions were hypodense, 19% were isodense, 16% were hyperdense, and 35% were mixed type of lesions. In that, 32% of the lesions had inhomogeneous enhancement while 28% had homogeneous enhancement. Rim was well defined in 12% of cases and ill-defined in 15% cases. While 13% cases did not show any type of differential findings. Common intracranial masses in children below 20 years of age were glioma (11) and abscess (9). While in adults along with glioma (20) other common masses are metastasis (10) and local spread (6).

Conclusion: In clinically suspected cases of intracranial SOLs, CT scanning have good sensitivity (100%) for picking up the lesions and mass effect. It is also exquisitely sensitive and shows localization and extent of disease process, and calcification very well. However, lack of multiplanar imaging and lack of precise tissue characterization limits its specificity of CT scanning in this study to 87%.

Key words: Supratentorial Mass Lesions; Intracranial Space Occupying Lesions; Computed Tomography


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