Acta Neurochirurgica

, Volume 160, Issue 4, pp 667–672 | Cite as

The role of computed tomography in the screening of patients presenting with symptoms of an intracranial tumour

  • Sharri Junadi Mortensen
  • Shima Naebi Bjerrum
  • Stine Frost Hedegaard
  • Anna Tietze
  • Hanne Gottrup
  • Gorm von Oettingen
Original Article - Brain Tumors



To improve the quality of care for brain cancer patients, the Danish Ministry of Health has set standards for the diagnosis and treatment. When a patient is suspected of having a malignant tumour involving the brain, it is required that a magnetic resonance imaging of the cerebrum (MRI-C) be obtained within seven calendar days of referral from a primary care provider. This standard has the potential to consume MR imaging time that might otherwise be used for evaluation or treatment monitoring of other patients. This study primarily aims to assess the sensitivity of computed tomography of the brain (CT-C) for the detection of intracranial tumour as the initial diagnostic imaging.


This is a single-center retrospective study of patients referred to the IBCP with brain cancer suspicion. The average follow-up was 37 months. All included patients underwent a CT-C scan and subsequently a MRI-C if deemed necessary. The study population was divided into two groups based on the findings: tumour versus non-tumour. Sensitivity and specificity of the CT-C was calculated.


Eight hundred seventeen patients were included. Median age was 55 years and 50% were male. CT-C had a sensitivity of 98.5% and a specificity of 98.4%. The overall mortality rate was 7% in the non-tumour group and 58% in the tumour group over the course of the study period. The tumour group was on average older compared to the non-tumour group (65 years [55–75 years] vs 52 years [38–65 years]) p < .001). The only symptom associated with brain tumour was the presence of a focal deficit (p = .002).


This study shows that CT-C scans are highly sensitive and specific and can be used as the primary screening tool for patients referred with a suspicion for brain cancer.


Brain tumour Diagnostic imaging CT-C MRI-C 



Computed tomography of the brain


Electronic patient journal


Initial brain cancer pathway


The Danish integrated cancer pathway


Magnetic resonance imaging of the cerebrum


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


For this type of study, formal consent is not required.


None of the people involved have any personal or institutional financial interest in drugs, materials, or devices described in this submission. Nothing to disclose.


  1. 1.
    Al-Okaili RN, Krejza J, Woo JH, Wolf RL, O’Rourke DM, Judy KD, Poptani H, Melhem ER (2007) Intraaxial brain masses: MR imaging–based diagnostic strategy—initial experience. Radiology 243(2):539–550CrossRefPubMedGoogle Scholar
  2. 2.
    Bjerre P, Broholm H, Bruun E, Hansen S, Hansen-Schwartz J, Juhler M, Laursen R, Poulsgaard L, Roed H, Sørensen L (2010) Retningslinjer for behandling af Meningeomer. Dansk Neuro Onkol Grup. Accessed 5 Jan 2017
  3. 3.
    Bradley WG, Waluch V, Yadley RA, Wycoff RR (1984) Comparison of CT and MR in 400 patients with suspected disease of the brain and cervical spinal cord. Radiology 152(3):695–702CrossRefPubMedGoogle Scholar
  4. 4.
    Brant-Zawadzki M, Badami JP, Mills CM, Norman D, Newton TH (1984) Primary intracranial tumor imaging: a comparison of magnetic resonance and CT. Radiology 150(2):435–440CrossRefPubMedGoogle Scholar
  5. 5.
    Cairncross JG, Kim JH, Posner JB (1980) Radiation therapy for brain metastases. Ann Neurol 7(6):529–541CrossRefPubMedGoogle Scholar
  6. 6.
    Cha S (2006) Update on brain tumor imaging: from anatomy to physiology. Am J Neuroradiol 27(3):475–487PubMedGoogle Scholar
  7. 7.
    DeAngelis LM (2001) Brain tumors. Med Prog N Engl J Med 114(2):114–123CrossRefGoogle Scholar
  8. 8.
    Fazekas F, Alavi A, Chawluk JB et al (1989) Comparison of CT, MR, and PET in Alzheimer’s dementia and normal aging. J Nucl Med 30(10):1607–1615PubMedGoogle Scholar
  9. 9.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2013) GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase. No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Accessed 5 Jan 2017
  10. 10.
    Helseth A (1997) Incidence and survival of intracranial meningioma patients in Norway 1963-1992. Neuroepidemiology 16(2):53–59CrossRefPubMedGoogle Scholar
  11. 11.
    Karantanas AH, Komnos A, Paterakis K, Hadjigeorgiou G (2005) Differences between CT and MR imaging in acute closed head injuries. C Extra Cases 29(1):1–8CrossRefGoogle Scholar
  12. 12.
    Kristensen CA, Roed H (2010) Hjernemetastaser. In: Co-op. Cancer Dep. Accessed 5 Feb 2017
  13. 13.
    Laursen EL, Rasmussen BK (2012) A brain cancer pathway in clinical practice. Dan Med J 59:A4437PubMedGoogle Scholar
  14. 14.
    Laursen EL, Rasmussen BK (2012) Work-up times in an integrated brain cancer pathway. Dan Med J 59:A4438PubMedGoogle Scholar
  15. 15.
    Leung D, Han X, Mikkelsen T, Nabors LB (2014) Role of MRI in primary brain tumor evaluation. J Natl Compr Cancer Netw 12(11):1561–1568CrossRefGoogle Scholar
  16. 16.
    Liang Z-P, Lauterbur PC (2000) Principles of magnetic resonance imaging: a signal processing perspective, vol 416. IEEE PressGoogle Scholar
  17. 17.
    Semelka RC, Armao DM, Elias J, Huda W (2007) Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging 25(5):900–909CrossRefPubMedGoogle Scholar
  18. 18.
    Silbergeld DL, Rostomily RC, Alvord EC (1991) The cause of death in patients with glioblastoma is multifactorial: clinical factors and autopsy findings in 117 cases of supratentorial glioblastoma in adults. J Neuro-Oncol 10(2):179–185CrossRefGoogle Scholar
  19. 19.
    Sundhedsdatastyrelsen (2015) Cancer incidence in Denmark. Danish Cancer Regist 1–4. Accessed 10 Feb 2017
  20. 20.
    Sundhedsdatastyrelsen (2016) Faktaanalyse– Kræftområdet 2007–2014. In: Sundhedsanalyser og Lægemiddelstatistik. Accessed 5 Jan 2017
  21. 21.
    Sundhedsstyrelsen (2013) Kræft i Hjernen. Hjernen3_1udg2013.pdf. Accessed 5 Jan 2017
  22. 22.
    Tietze A, Choi C, Mickey B, Maher EA, Parm Ulhøi B, Sangill R, Lassen-Ramshad Y, Lukacova S, Østergaard L, von Oettingen G (2017) Noninvasive assessment of isocitrate dehydrogenase mutation status in cerebral gliomas by magnetic resonance spectroscopy in a clinical setting. J Neurosurg 3:1–8Google Scholar
  23. 23.
    Wen PY, Macdonald DR, Reardon DA et al (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28(11):1963–1972CrossRefPubMedGoogle Scholar
  24. 24.
    Zimmerman RA, Bilaniuk LT, Johnson MH, Hershey B, Jaffe S, Gomori JM, Goldberg HI, Grossman RI (1986) MRI of central nervous system: early clinical results. AJNR Am J Neuroradiol 7(4):587–594PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Sharri Junadi Mortensen
    • 1
    • 2
  • Shima Naebi Bjerrum
    • 1
  • Stine Frost Hedegaard
    • 1
    • 2
  • Anna Tietze
    • 3
  • Hanne Gottrup
    • 2
  • Gorm von Oettingen
    • 1
  1. 1.Department of NeurosurgeryAarhus University HospitalAarhusDenmark
  2. 2.Department of NeurologyAarhus University HospitalAarhusDenmark
  3. 3.Institute of NeuroradiologyCharité UniversitätsmedizinBerlinGermany

Personalised recommendations