Evaluation of Response to Stereotactic Radiosurgery in Brain Metastases Using Multiparametric Magnetic Resonance Imaging and a Review of the Literature

Sawlani, Vijay; Davies, Nigel P.; Patel, Mohit; Flintham, Robert; Fong, C.; Heyes, G.; Cruickshank, Garth; Steven, Neil; Peet, Andrew C.; Hartley, A.; Benghiat, Helen; Meade, Sara; Sanghera, Paul

doi:10.1016/j.clon.2018.09.003

Cited by 19 publications

(22 citation statements)

References 33 publications

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“…5 Given that early volume expansion may be relatively common, the value of short interval conventional imaging and a 3-month response assessment, as carried out in many early phase studies, is called into question. 27 All nine metastatic lesions in our study showed an elevated TSC at baseline compared to the contralateral normalappearing brain area with a mean of 73.4 ± 12.3 mM (mean rTSC 53% ± 19%). These values correlate well with data published by Ouwerkerk et al who reported an elevated TSC with a mean of 105 ± 24 mM in malignant brain tumors.…”

Section: Discussionmentioning

confidence: 52%

“…Furthermore, it was previously shown that radiation‐sensitive metastases can show volume shrinkage early after SRS (<30 days); however, shrinkage of radiation‐resistant metastatic tumors may take longer than 30 days 5 . Given that early volume expansion may be relatively common, the value of short interval conventional imaging and a 3‐month response assessment, as carried out in many early phase studies, is called into question 27 …”

Section: Discussionmentioning

confidence: 99%

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MRI Detection of Changes in Tissue Sodium Concentration in Brain Metastases after Stereotactic Radiosurgery: A Feasibility Study

Mohamed

Adlung

Ruder

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: To date, treatment response to stereotactic radiosurgery (SRS) in brain metastases (BM) can only be determined by MRI evaluation of contrast-enhancing lesions in a long-time follow-up. Sodium MRI has been a subject of immense interest in imaging research as the measure of tissue sodium concentration (TSC) can give valuable quantitative information on cell viability. We aimed to analyze the longitudinal changes of TSC in BM measured with 23 Na MRI before and after SRS for assessment of early local tumor effects. METHODS: Seven patients with a total of 12 previously untreated BM underwent SRS with 22 Gy. In addition to a standard MRI protocol including dynamic susceptibility-weighted contrast-enhanced perfusion, a 23 Na MRI was performed at three time points: (I) 2 days before, (II) 5 days, and (III) 40 days after SRS. Nine BMs were evaluated. The absolute TSC in the BM, the respective peritumoral edemas, and the normal-appearing corresponding contralateral brain area were assessed and the relative TSC were correlated to the changes in BM longest axial diameters. RESULTS: TSC was elevated in nine BM at baseline before SRS with a mean of 73.4 ± 12.3 mM. A further increase in TSC was observed 5 days after SRS in all the nine BM with a mean of 86.9 ± 13 mM. Eight of nine BM showed a mean 60.6 ± 13.3% decrease in the longest axial diameter 40 days after SRS; at this time point, the TSC also had decreased to a mean 65.1 ± 7.9 mM. In contrast, one of the nine BM had a 13.4% increase in the largest axial diameter at time point III. The TSC of this BM showed a further TSC increase of 80.1 mM 40 days after SRS. CONCLUSION: Changes in TSC using 23 Na MRI shows the possible capability to detect radiobiological changes in BM after SRS.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

MRI Detection of Changes in Tissue Sodium Concentration in Brain Metastases after Stereotactic Radiosurgery: A Feasibility Study

Mohamed

Adlung

Ruder

et al. 2020

Journal of Neuroimaging

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“…Using the appropriate imaging modality for treatment planning, SBRT offers an excellent local control with acceptable toxicity pro le 21 . However, response assessment after SBRT is a challenging topic, which is not only limited to the bone, as we confront di culties to interpret the changes in imaging modalities after stereotactic radiotherapy in other organs, like brain, liver and lung [22][23][24] . Appropriate evaluating of diagnostic images is a critical point in the process of the disease and can prevent the risks of unnecessary interventions.…”

Section: Discussionmentioning

confidence: 99%

Response Assessment After Stereotactic Body Radiation Therapy for Spine and Non-spine Bone Metastases: Results From a Single Institutional Study

Correia

Moullet

Cullmann

et al. 2021

Preprint

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Background The use of stereotactic body radiation therapy (SBRT) for tumor- and pain control in patients with bone metastases is increasing. Here, we report response assessment after bone SBRT using radiological changes through time and clinical examination of patients. MethodsWe analyzed retrospectively the oligo-metastatic/progressive patients with bony lesions treated with SBRT between 12/2008 and 10/2018 in our institution. Radiological data were obtained from imaging modalities used for SBRT planning and follow-up (FU) purposes in PACS and assessed by two independent radiologists blind to the time of treatment. Several radiological changes were described. Radiographic response assessment was classified according to University of Texas MD Anderson Cancer Center criteria. Pain response was captured pre- and >= 6 months post-SBRT.ResultsA total of 35 of the 74 reviewed patients were eligible, presenting 43 bone metastases, with 51.2% (n=22) located in vertebral column. Median age at the time of SBRT was 66 years (range, 38-84), and 77.1% (n=27) were male. Histology was mainly prostate (51.4%, n=18) and breast cancer (14.3%, n=5). Median total radiation dose delivered was 24 Gy (range: 24-42), in three fractions (range: 2-7), prescribed to 70 - 90% isodose-line. After a median FU of 1.8 years (range, 0.1-8.2) for survivors, complete-/ partial response, stable (SD), and progressive disease occurred in 0%, 11.4% (n=4), 68.6% (n=24) and 20.0% (n=7) of the patients respectively. Twenty patients (57.1%) died during the FU time, all from disease progression, yet 70% (n=14) from this population with local SD after SBRT. From patients who were symptomatic and available for FU, almost 50% reported pain reduction after SBRT.ConclusionsEighty percent of the patients showed local control (LC) after SBRT for bone metastases. Pain response was favorable. For more accurate response assessment, comparing current imaging modalities with advanced imaging techniques such as functional MRI and PET-CT is warranted.Trial registrationRetrospectively registered.

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“…Following SRS, one-third of brain metastases increase in size, suggesting treatment failure [39]. Conventional MRI cannot differentiate between SRS-induced changes and tumour recurrence; however, combining multiparametric MRI techniques has shown promise in answering this clinical question [6]. The typical appearances in SRS-related treatment effect are high ADC (> 1000 × 10 −6 mm 2 s −1 ), low rCBV ratio (< 2.1) and a low Cho/Cr ratio (< 1.8) and presence of lipid suggesting necrosis as demonstrated in the case shown in Fig.…”

Section: Metastasis-treatment Responsementioning

confidence: 99%

“…Changes in physiological processes due to the nature of the underlying lesion are reflected in the information obtained. There have been a number of studies demonstrating that these techniques in combination can help improve differentiation of neoplastic from non-neoplastic lesions (for example, tumefactive demyelination, tumefactive vasculitis and other inflammatory disorders) [2,3], grading of brain tumours [4], differentiation of glioblastoma pseudoprogression from true progression [5] and response of brain metastases to stereotactic radiosurgery (SRS) treatment [6]. Over time, there has been development of these adjunct advanced MRI techniques in isolation, beginning with MRS, DWI and then PWI.…”

Section: Introductionmentioning

confidence: 99%

Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions

et al. 2020

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MRI has a vital role in the assessment of intracranial lesions. Conventional MRI has limited specificity and multiparametric MRI using diffusion-weighted imaging, perfusion-weighted imaging and magnetic resonance spectroscopy allows more accurate assessment of the tissue microenvironment. The purpose of this educational pictorial review is to demonstrate the role of multiparametric MRI for diagnosis, treatment planning and for assessing treatment response, as well as providing a practical approach for performing and interpreting multiparametric MRI in the clinical setting. A variety of cases are presented to demonstrate how multiparametric MRI can help differentiate neoplastic from non-neoplastic lesions compared to conventional MRI alone.

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Evaluation of Response to Stereotactic Radiosurgery in Brain Metastases Using Multiparametric Magnetic Resonance Imaging and a Review of the Literature

Cited by 19 publications

References 33 publications

MRI Detection of Changes in Tissue Sodium Concentration in Brain Metastases after Stereotactic Radiosurgery: A Feasibility Study

MRI Detection of Changes in Tissue Sodium Concentration in Brain Metastases after Stereotactic Radiosurgery: A Feasibility Study

Response Assessment After Stereotactic Body Radiation Therapy for Spine and Non-spine Bone Metastases: Results From a Single Institutional Study

Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions

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