title: Prognostic significance of CT contrast enhancement within histological subgroups of intracranial glioma.
abstract: We report the prognostic significance of tumor CT contrast enhancement within histological subgroups in 831 consecutive adult glioma patients of high-grade (n = 516) and low-grade (n = 315) histology. In the present report, a negative prognostic factor is associated with shortened survival.
  
  
  METHODS
  Survival analysis including Kaplan-Meier plots, log-rank tests, Cox analysis, and Aalen's linear model as implemented in SPSS and S-PLUS.
  
  
  RESULTS
  Sensitivity and specificity of contrast enhancement as a test for high-grade glioma was 0.87 and 0.79, respectively. Enhancement was a strong negative prognostic factor comparable to high-grade histology in the total patient population. Enhancement was also a negative prognostic factor within the subgroups adult high-grade (Grade 3-4), anaplastic (Grade 3), and low-grade (Grade 1-2) gliomas (p < 0.001). The prognostic implications of initial enhancement declined in high-grade patients surviving beyond 36 months. Tumor contrast enhancement or calcifications (in parentheses) were present in 96% (3.6%) of glioblastomas, in 87% (7.4%) of high-grade gliomas, in 56.5% of anaplastic gliomas, and in 21% (16.2%) of low-grade gliomas. Calcification was a positive prognostic factor within the high-grade group of patients (p < 0.0001).
  
  
  CONCLUSIONS
  Enhancement was a major prognostic factor comparable to high-grade histology in this glioma patient population. Enhancement was a negative prognostic factor within each of the adult subgroups high-grade, anaplastic (grade 3), and low-grade gliomas. Enhancement was strongly associated with but not pathognomonic for high-grade histology.
authors.affiliation: Department of Oncology, Norwegian Radium Hospital, Oslo.
authors.forename: K
authors.initials: K
authors.lastname: Lote
authors.forename: T
authors.initials: T
authors.lastname: Egeland
authors.forename: B
authors.initials: B
authors.lastname: Hager
authors.forename: K
authors.initials: K
authors.lastname: Skullerud
authors.forename: H
authors.initials: H
authors.lastname: Hirschberg
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed