CT perfusion–focused preoperative assessment of the blood-supplying state among imaging modalities in skull base chordoma: a retrospective single-center cohort

The blood-supplying state of skull base chordomas has been scarcely investigated. We aimed to elucidate the role and superiority of CT perfusion (CTP) in predicting the tumor blood-supplying state to guide surgical strategy. Between 2023 and 2024, 79 consecutive patients with skull base chordoma treated at Beijing Tiantan Hospital were retrospectively identified, and their clinical, imaging, and pathological data were analyzed. We further attempted to establish a grading system for the tumor blood-supplying state. Differences among blood-supplying state groups were assessed, and associations between imaging parameters and the blood-supplying state were examined. CTP can distinguish different blood-supplying states of skull base chordoma (rCBF: P = 0.006; rCBV: P < 0.001). CTP (rCBF: r = 0.361, P = 0.001; rCBV: r = 0.425, P < 0.001) has an advantage over MRI (T2WI: r=-0.353, P = 0.001; contrast-enhanced T1WI: r = 0.383, P < 0.001; nADC: r = 0.084, P = 0.462) in reflecting the skull base chordoma blood-supplying state. Between the two CTP parameters, rCBV demonstrated higher diagnostic value than rCBF. Although both could distinguish rich from poor blood-supply (rCBF: 1.90 vs.0.98, r = 0.359, P < 0.01, 95%CI[0.198, 1.253]; rCBV: 3.09 vs.1.55, r = 0.420, P < 0.001, 95%CI[0.728, 2.335]), only rCBV was sensitive enough to differentiate the moderate from the poor blood-supply group (1.55 vs.2.30, r = 0.277, P < 0.05, 95%CI[0.122, 1.263]). CTP can be used to judge the blood-supplying states of skull base chordomas, which helps plan the surgical strategy.