Effective atomic number and electron density from dual-energy CT for differentiating malignant gliomas: Validation using the World Health Organization 2021 brain tumor classification

Based on the World Health Organization (WHO) 2021 brain tumor pathology classification, we evaluated the usefulness of dual-energy CT (DECT) for differentiating malignancy grades in malignant gliomas and examined its correlation with amide proton transfer (APT). A prospective observational study was conducted on 49 patients: 16 with glioblastoma (GBM, grade 4), 13 with astrocytoma (A3, grade 3), 10 with oligodendroglioma (O3, grade 3), and 10 with oligodendroglioma (O2, grade 2). Effective atomic number (Zeff) and electron density (ED) from DECT were analyzed for tumor grade differentiation and correlation with APT. High-grade gliomas, which are influenced by vascular endothelial growth factor (VEGF) and microvascular proliferation, showed significant differences and correlations in post-contrast Zeff. A correlation between Zeff and MIB-1 suggests its potential as an indicator of cell proliferation. Additionally, correlations between Zeff and APT, as well as between ED and APT, indicate that DECT may be useful for grading malignant gliomas.