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RT Journal Article
SR Electronic
T1 Distinguishing Recurrent Primary Brain Tumor from Radiation Injury: A Preliminary Study Using a Susceptibility-Weighted MR Imaging−Guided Apparent Diffusion Coefficient Analysis Strategy
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1049
OP 1054
DO 10.3174/ajnr.A2011
VO 31
IS 6
A1 Al Sayyari, A.
A1 Buckley, R.
A1 McHenery, C.
A1 Pannek, K.
A1 Coulthard, A.
A1 Rose, S.
YR 2010
UL http://www.ajnr.org/content/31/6/1049.abstract
AB BACKGROUND AND PURPOSE: The accurate delineation of tumor recurrence presents a significant problem in neuro-oncology. Our aim was to improve the identification of brain tumor recurrence from chemoradiation injury by using CE-SWI, a technique that provides improved visualization of the heterogeneous patterns of brain tumor pathology, to guide the analysis of ADC measures within the peritumoral territory. MATERIALS AND METHODS: Seventeen patients who were being treated for high-grade glial neoplasms took part in the study. All patients presented with new enhancing lesions on follow-up CE-T1. Recurrence or chemoradiation injury was confirmed from either histologic analysis or extensive clinical follow-up. Regions of enhancement on registered CE-SWI and CE-T1 images were extracted in a semiautomated fashion and transferred to coregistered ADC maps. Significant differences in ADC measures defined within the enhancement volumes on serial MR images were analyzed by using a nonparametric Kolmogorov-Smirnov approach and correlated with clinical follow-up diagnoses. RESULTS: Analysis of the serial data revealed that patients with a diagnosis of tumor recurrence had significantly reduced ADC measures within the enhancement volume delineated on CE-SWI. In contrast, patients with SD had significantly elevated ADC within the CE-SWI enhancement volume. CONCLUSIONS: The findings of an increase in enhancement volume delineated on serial CE-SWI maps, along with a concomitant reduction in ADC within this volume for patients with recurrent tumor, provide support for such an approach to be used to assist in follow-up patient management strategies. ADCapparent diffusion coefficientBBBblood-brain barrierCE-SWIcontrast-enhanced susceptibility-weighted imagingCE-T1contrast-enhanced T1-weighted imagingFMRIBFunctional Magnetic Resonance Imaging of the BrainGBMglioblastoma multiformeMRIMR imagingNo Eno constant enhancementPseudoevidence of a secondary pseudoprogressive lesionRTrecurrent tumorSDstable diseaseSWIsusceptibility-weighted imagingVolvolumeWHOWorld Health Organization