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<meta name="DC.Title" content="Can nonenhancing white matter lesions in cancer patients be disregarded?" />
<meta name="DC.Date" content="1992-09-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
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<meta name="DC.Description" content="PURPOSE To assess the risks and implications of assuming that white matter lesions in cancer patients that do not enhance with gadopentetate dimeglumine (Gd-DTPA) can be considered to be benign.

METHODS Gd-DTPA was administered prospectively to 131 consecutive patients with biopsy-proved extracranial malignancies referred for cranial MR imaging to exclude cerebral metastases over a 21/2-year period. From this initial group, 50 patients were identified who had focal nonenhancing lesions of the white matter on T2-weighted images, but no other findings to suggest metastatic disease. This cohort of 50 patients was then followed for at least 1 year to determine the risk and clinical implications of assuming these nonenhancing white matter lesions were benign.

RESULTS Thirty patients (60%) were alive and clinically free of cranial metastatic disease at least 1 year following their initial MR study (median follow-up time, 17 months). Twenty of the 50 patients (40%) died within 1 year of their study (median survival, 4.1 months). Review of clinic notes and hospital charts revealed no evidence for deterioration of neurologic status in any of these patients before death, and the cause of death in each case was ascribed to extracranial complications of their systemic malignancies. Eight of these 20 patients who expired had at least one follow-up cranial CT or MR scan before death showing no new cerebral metastases or change in the nonenhancing white matter lesions previously identified. In a single patient, however, follow-up MR scan revealed conversion of one of her several white matter lesions from nonenhancing to enhancing without appreciable change in its size on T2-weighted images. Unfortunately, this patient died 4 months later from surgical complications without interval change in her neurologic status nor pathologic proof of the nature of this lesion.

CONCLUSIONS White matter lesions in cancer patients that do not enhance with Gd-DTPA at the time of the initial MR study have a low probability of representing metastatic disease. Clinical management or final outcome will not likely be altered by assuming such lesions are benign." />
<meta name="DC.Contributor" content="A D Elster" />
<meta name="DC.Contributor" content="M Y Chen" />
<meta name="article:published_time" content="1992-09-01" />
<meta name="citation_title" content="Can nonenhancing white matter lesions in cancer patients be disregarded?" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;PURPOSE&lt;/h3&gt;
&lt;p&gt;To assess the risks and implications of assuming that white matter lesions in cancer patients that do not enhance with gadopentetate dimeglumine (Gd-DTPA) can be considered to be benign.&lt;/p&gt;&lt;h3&gt;METHODS&lt;/h3&gt;
&lt;p&gt;Gd-DTPA was administered prospectively to 131 consecutive patients with biopsy-proved extracranial malignancies referred for cranial MR imaging to exclude cerebral metastases over a 21/2-year period. From this initial group, 50 patients were identified who had focal nonenhancing lesions of the white matter on T2-weighted images, but no other findings to suggest metastatic disease. This cohort of 50 patients was then followed for at least 1 year to determine the risk and clinical implications of assuming these nonenhancing white matter lesions were benign.&lt;/p&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;
&lt;p&gt;Thirty patients (60%) were alive and clinically free of cranial metastatic disease at least 1 year following their initial MR study (median follow-up time, 17 months). Twenty of the 50 patients (40%) died within 1 year of their study (median survival, 4.1 months). Review of clinic notes and hospital charts revealed no evidence for deterioration of neurologic status in any of these patients before death, and the cause of death in each case was ascribed to extracranial complications of their systemic malignancies. Eight of these 20 patients who expired had at least one follow-up cranial CT or MR scan before death showing no new cerebral metastases or change in the nonenhancing white matter lesions previously identified. In a single patient, however, follow-up MR scan revealed conversion of one of her several white matter lesions from nonenhancing to enhancing without appreciable change in its size on T2-weighted images. Unfortunately, this patient died 4 months later from surgical complications without interval change in her neurologic status nor pathologic proof of the nature of this lesion.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;
&lt;p&gt;White matter lesions in cancer patients that do not enhance with Gd-DTPA at the time of the initial MR study have a low probability of representing metastatic disease. Clinical management or final outcome will not likely be altered by assuming such lesions are benign.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="1992/09/01" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
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<meta name="citation_author" content="A D Elster" />
<meta name="citation_author_institution" content="Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1022." />
<meta name="citation_author" content="M Y Chen" />
<meta name="citation_author_institution" content="Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1022." />
<meta name="twitter:title" content="Can nonenhancing white matter lesions in cancer patients be disregarded?" />
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<meta name="twitter:description" content="PURPOSE To assess the risks and implications of assuming that white matter lesions in cancer patients that do not enhance with gadopentetate dimeglumine (Gd-DTPA) can be considered to be benign.

METHODS Gd-DTPA was administered prospectively to 131 consecutive patients with biopsy-proved extracranial malignancies referred for cranial MR imaging to exclude cerebral metastases over a 21/2-year period. From this initial group, 50 patients were identified who had focal nonenhancing lesions of the white matter on T2-weighted images, but no other findings to suggest metastatic disease. This cohort of 50 patients was then followed for at least 1 year to determine the risk and clinical implications of assuming these nonenhancing white matter lesions were benign.

RESULTS Thirty patients (60%) were alive and clinically free of cranial metastatic disease at least 1 year following their initial MR study (median follow-up time, 17 months). Twenty of the 50 patients (40%) died within 1 year of their study (median survival, 4.1 months). Review of clinic notes and hospital charts revealed no evidence for deterioration of neurologic status in any of these patients before death, and the cause of death in each case was ascribed to extracranial complications of their systemic malignancies. Eight of these 20 patients who expired had at least one follow-up cranial CT or MR scan before death showing no new cerebral metastases or change in the nonenhancing white matter lesions previously identified. In a single patient, however, follow-up MR scan revealed conversion of one of her several white matter lesions from nonenhancing to enhancing without appreciable change in its size on T2-weighted images. Unfortunately, this patient died 4 months later from surgical complications without interval change in her neurologic status nor pathologic proof of the nature of this lesion.

CONCLUSIONS White matter lesions in cancer patients that do not enhance with Gd-DTPA at the time of the initial MR study have a low probability of representing metastatic disease. Clinical management or final outcome will not likely be altered by assuming such lesions are benign." />
<meta name="og-title" property="og:title" content="Can nonenhancing white matter lesions in cancer patients be disregarded?" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/13/5/1309" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="PURPOSE To assess the risks and implications of assuming that white matter lesions in cancer patients that do not enhance with gadopentetate dimeglumine (Gd-DTPA) can be considered to be benign.

METHODS Gd-DTPA was administered prospectively to 131 consecutive patients with biopsy-proved extracranial malignancies referred for cranial MR imaging to exclude cerebral metastases over a 21/2-year period. From this initial group, 50 patients were identified who had focal nonenhancing lesions of the white matter on T2-weighted images, but no other findings to suggest metastatic disease. This cohort of 50 patients was then followed for at least 1 year to determine the risk and clinical implications of assuming these nonenhancing white matter lesions were benign.

RESULTS Thirty patients (60%) were alive and clinically free of cranial metastatic disease at least 1 year following their initial MR study (median follow-up time, 17 months). Twenty of the 50 patients (40%) died within 1 year of their study (median survival, 4.1 months). Review of clinic notes and hospital charts revealed no evidence for deterioration of neurologic status in any of these patients before death, and the cause of death in each case was ascribed to extracranial complications of their systemic malignancies. Eight of these 20 patients who expired had at least one follow-up cranial CT or MR scan before death showing no new cerebral metastases or change in the nonenhancing white matter lesions previously identified. In a single patient, however, follow-up MR scan revealed conversion of one of her several white matter lesions from nonenhancing to enhancing without appreciable change in its size on T2-weighted images. Unfortunately, this patient died 4 months later from surgical complications without interval change in her neurologic status nor pathologic proof of the nature of this lesion.

CONCLUSIONS White matter lesions in cancer patients that do not enhance with Gd-DTPA at the time of the initial MR study have a low probability of representing metastatic disease. Clinical management or final outcome will not likely be altered by assuming such lesions are benign." />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A D Elster</span> and <span class="highwire-citation-author" data-delta="1">M Y Chen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 1992,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">13 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1309-1315; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-5516--6295555853" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A D Elster </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1022.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A%2BD%2BElster%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Elster%20AD&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA%2BD%2BElster%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M Y Chen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1022.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M%2BY%2BChen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chen%20MY&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM%2BY%2BChen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 13</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 1992 </div></div>
      
      
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