Glioma Recurrence Versus Radiation Necrosis?

Özsunar, Yelda; Mullins, Mark E.; Kwong, Kenneth K.; Hochberg, Fred H.; Ament, Christine Shortsleeve; Schaefer, Pamela W.; González, R. Gilberto; Lev, Michael H.

doi:10.1016/j.acra.2009.10.024

Cited by 128 publications

(67 citation statements)

References 37 publications

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“…Multiple groups have attempted to address this challenge through various imaging approaches targeting fundamental differences between the pathologies. Specifically, researchers have looked at differences in blood flow and perfusion (26-28), metabolism (28-30), and cellularity and tissue composition (30-32). The work presented herein is distinct from prior studies in that the Leskel Gamma Knife mouse irradiation model is a single hemisphere model of radiation injury that recapitulates all of the histologic hallmarks of the clinical lesion (22, 23) while allowing use of the unaffected hemisphere as a valuable control within each subject, data were acquired at multiple times during progression of the injury models, and results are presented for a combined irradiated glioma model, rather than solely for each pathology alone.…”

Section: Discussionmentioning

confidence: 99%

Toward Distinguishing Recurrent Tumor From Radiation Necrosis: DWI and MTC in a Gamma Knife–Irradiated Mouse Glioma Model

Pérez-Torres

Engelbach

Cates

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose Accurate non-invasive diagnosis is vital for effective treatment planning. Presently, standard anatomical MRI is incapable of differentiating recurring tumor from delayed radiation injury, as both lesions are hyperintense in both post-contrast T1- and T2-weighted images. Further studies are therefore necessary to identify an MRI paradigm that can differentially diagnose these pathologies. Mouse glioma and radiation injury models provide a powerful platform for this purpose. Methods and Materials Two MRI contrasts that are widely employed in the clinic were chosen for application with a glioma/radiation-injury model: diffusion weighted imaging, from which the apparent diffusion coefficient (ADC) is obtained, and magnetization transfer contrast, from which the magnetization transfer ratio (MTR) is obtained. These metrics were evaluated longitudinally, first in each lesion type alone – glioma vs. irradiation - and then in a combined irradiated glioma model. Results MTR was found to be consistently decreased in all lesions compared to nonlesion brain tissue (contralateral hemisphere), with limited specificity between lesion types. In contrast, ADC, though less sensitive to the presence of pathology, was increased in radiation injury and decreased in tumors. In the irradiated glioma model, ADC also increased immediately after irradiation, but decreased as the tumor regrew. Conclusions ADC is a better metric than MTR for differentiating glioma from radiation injury. However, MTR was more sensitive to both tumor and radiation injury than ADC, suggesting a possible role in detecting lesions that do not enhance strongly on T1-weighted images.

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Section: Discussionmentioning

confidence: 99%

Toward Distinguishing Recurrent Tumor From Radiation Necrosis: DWI and MTC in a Gamma Knife–Irradiated Mouse Glioma Model

Pérez-Torres

Engelbach

Cates

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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“…Though rCBV analysis is clearly helpful in differentiating recurrent tumor from radiation necrosis, the presence of such outliers limits the ability of DSC MR perfusion to accurately distinguish radiation necrosis from recurrent tumor. To further increase sensitivity and specificity for the differentiation of recurrent neoplasm from radiation necrosis in the daily clinical setting, a multi-sequence, multi-modality approach including MR spectroscopy and positron emission tomography (PET) may be helpful (7, 19, 20, 24, 25). The evaluation of such imaging techniques/modalities were beyond the scope of this study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis

et al. 2016

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Rationale and Objectives To compare differences in diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrastenhanced (DSC) MR perfusion imaging characteristics of recurrent neoplasm and radiation necrosis in patients with brain tumors previously treated with radiotherapy with or without surgery and chemotherapy. Methods and Materials Patients with a history of brain neoplasm previously treated with radiotherapy with or without chemotherapy and surgery who developed a new enhancing lesion on post-treatment surveillance MRI were enrolled. DSC perfusion MR imaging and DTI were performed. Region of interest (ROI) cursors were manually drawn in the contrast enhancing lesions, in the perilesional white matter edema, and in the contralateral normal-appearing frontal lobe white matter. DTI and DSC perfusion MR indices were compared in recurrent tumor versus radiation necrosis. Results Twenty-two patients with 24 lesions were included. Sixteen (67%) lesions were placed into the recurrent neoplasm group and 8 (33%) were placed into the radiation necrosis group using biopsy results as the gold standard in all but 3 patients. Mean ADC values, mean parallel eigenvalues, and mean perpendicular eigenvalues in the contrast enhancing lesion were significantly lower and relative cerebral blood volume was significantly higher for the recurrent neoplasm group compared to the radiation necrosis group (p<0.01, p=0.03, p<0.01, and p<0.01 respectively). Conclusion The combined assessment of DTI and DSC MR perfusion properties of new contrast enhancing lesions is helpful in distinguishing recurrent neoplasm from radiation necrosis in patients with a history of brain neoplasm previously treated with radiotherapy with or without surgery and chemotherapy.

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“…Thus, a comprehensive imaging modality is the most practical and common diagnostic method for radiation brain necrosis in clinical practice [12]. In this study, the patients were diagnosed based on a comprehensive medical history, symptoms, signs, MRI, spectroscopy and positron emission tomography-computed tomography (PET-CT) [13–20]. MRI or spectroscopy was performed first, and then, PET-CT was performed as needed for ambivalent diagnoses.…”

Section: Methodsmentioning

confidence: 99%

Exploration of the recurrence in radiation brain necrosis after bevacizumab discontinuation

et al. 2016

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Objective: The aim of the paper was to investigate the recurrence and its causes of radiation brain necrosis following bevacizumab discontinuation. Methods: This study included 14 patients with radiation brain necrosis (confirmed through imaging) after stereotactic radiotherapy for a primary or metastatic brain tumor and who received bevacizumab treatment from June 2011 through December 2014. The patients received bevacizumab at 5 mg/kg, q3-4w, for at least 3 cycles. The T1 signal intensity from enhanced MRI images was used as the evaluation criteria for the brain necrosis treatment efficacy. Results: brain necrosis improved in 13 of the 14 cases (92.9%). However, during follow-up, 10 of the 13 responsive patients (76.9%) exhibited a recurrence in brain necrosis, and a multiple linear regression analysis shows that brain necrosis recurrence was related to the follow-up time after the initial bevacizumab treatment discontinuation. Conclusion: bevacizumab produced good short-term effects for radiation brain necrosis; however, most of the patients would recurrence after bevacizumab is discontinued. Thus, brain necrosis was irreversible.

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Glioma Recurrence Versus Radiation Necrosis?

Cited by 128 publications

References 37 publications

Toward Distinguishing Recurrent Tumor From Radiation Necrosis: DWI and MTC in a Gamma Knife–Irradiated Mouse Glioma Model

Toward Distinguishing Recurrent Tumor From Radiation Necrosis: DWI and MTC in a Gamma Knife–Irradiated Mouse Glioma Model

Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis

Exploration of the recurrence in radiation brain necrosis after bevacizumab discontinuation

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