Can Standard Magnetic Resonance Imaging Reliably Distinguish Recurrent Tumor from Radiation Necrosis after Radiosurgery for Brain Metastases? A Radiographic-Pathological Study

2009 ◽  
Vol 2009 ◽  
pp. 246-247
Author(s):  
G. Rao
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Metastases ◽  
Radiation Necrosis ◽  
Recurrent Tumor ◽  
Resonance Imaging ◽  
Pathological Study ◽  
Standard Magnetic Resonance Imaging

CAN STANDARD MAGNETIC RESONANCE IMAGING RELIABLY DISTINGUISH RECURRENT TUMOR FROM RADIATION NECROSIS AFTER RADIOSURGERY FOR BRAIN METASTASES? A RADIOGRAPHIC-PATHOLOGICAL STUDY

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 898-904 ◽  
Author(s):  
Ivan M. Dequesada ◽  
Ronald G. Quisling ◽  
Anthony Yachnis ◽  
William A. Friedman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Radiation Necrosis ◽  
Cyst Formation ◽  
Recurrent Tumor ◽  
Resonance Imaging ◽  
Metastatic Brain Tumors ◽  
Arteriovenous Shunting ◽  
Perilesional Edema ◽  
Standard Magnetic Resonance Imaging

Abstract OBJECTIVE Stereotactic radiosurgery is a commonly used treatment method in the management of metastatic brain tumors. When lesions enlarge after radiosurgery, it may represent tumor regrowth, radiation necrosis, or both. The purpose of this study was to determine whether standard magnetic resonance imaging (MRI) sequences could reliably distinguish between these pathological possibilities. METHODS A total of 619 patients, reported in a previous study, were treated with radiosurgery for metastatic brain tumors. Of those patients, 59 underwent subsequent craniotomy for symptomatic lesion enlargement. Of those 59 patients, 32 had complete preoperative MRI studies as well as surgical pathology reports. The following MRI features were analyzed in this subset of patients: arteriovenous shunting, gyriform lesion or edema distribution, perilesional edema, cyst formation, and pattern of enhancement. A novel radiographic feature, called the lesion quotient, which is the ratio of the nodule as seen on T2 imaging to the total enhancing area on T1 imaging, was also analyzed. RESULTS Sensitivity, specificity, and predictive values were computed for each radiographic characteristic. Lesions containing only radiation necrosis never displayed gyriform lesion/edema distribution, marginal enhancement, or solid enhancement. All lesions exhibited perilesional edema. A lesion quotient of 0.6 or greater was seen in all cases of recurrent tumor, a lesion quotient greater than 0.3 was seen in 19 of 20 cases of combination pathology, and a lesion quotient of 0.3 or less was seen in 4 of 5 cases of radiation necrosis. The lesion quotient correlated with the percentage of tumor identified on pathological specimens. CONCLUSION The lesion quotient appears to reliably identify pure radiation necrosis on standard sequence MRI. Other examined radiographic features, including arteriovenous shunting, gyriform lesion/edema distribution, enhancement pattern, and cyst formation, achieved 80% or greater predictive value but had either low sensitivity or low specificity.

P05.01 Prospective validation trial of magnetic resonance imaging based Contrast Clearance Analysis (CCA) to differentiate between pseudoprogression/radiation necrosis and progressive disease following cranial radiotherapy

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii23-ii23
Author(s):  
R Bodensohn ◽  
R Forbrig ◽  
S Lietke ◽  
J Reis ◽  
A Boulesteix ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Metastases ◽  
Progressive Disease ◽  
Radiation Necrosis ◽  
Histopathological Diagnosis ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Cranial Radiotherapy ◽  
Significance Level

Abstract BACKGROUND Pseudoprogression (PsP) or radiation necrosis (RN) may frequently occur after cranial radiotherapy and show a similar imaging pattern compared to progressive disease (PD). Even for experienced neuroradiologists, it remains challenging to distinguish between these clinically relevant disease states. We aimed to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) based Contrast Clearance Analysis (CCA) in this clinical setting. MATERIAL AND METHODS Patients with equivocal imaging findings after cranial radiotherapy were consecutively included into this monocentric prospective study. Assuming a true accuracy of 90% and setting the significance level to 0.05, N=33 patients are required to show that accuracy is larger than 70% with a power of 80% using a one-sided binomial test. CCA was performed by subtraction of imaging features in late vs early T1-weighted sequences after contrast-agent application. Two experienced neuroradiologists evaluated CCA with respect to PsP/RN and PD being blinded for FET PET and histological findings; histopathological diagnosis was based on stereotactic biopsy or resection for space-occupying processes. The radiological assessment was compared with the histopathological results, and its accuracy was calculated statistically. RESULTS Thirty-three patients were included; sixteen (48.5%) were treated because of a primary brain tumors, and 17 (51.1%) with brain metastases. In one patient, CCA was technically infeasible. The accuracy of CCA in predicting the histological result was 0.84 (95% CI 0.67–0.95; one-sided p=0.05; N=32). An accuracy of 0.85 (95% CI 0.68–0.95; one-sided p=0.04) would have been obtained in case of a correct classification in the non-analyzable case. Sensitivity and specificity of CCA were 0.93 (95%-CI 0.66–1.00) and 0.78 (95% CI 0.52–0.94), respectively. The accuracy in metastases patients was 0.94 (95% CI 0.71 - 1.00) and non-significantly higher compared to primary brain tumor patients with accuracy of 0.73 (95% CI 0.45 - 0.92), p=0.16. CONCLUSION In this study, CCA was a highly accurate, easy and helpful method for distinguishing PsP or RN from PD after cranial radiotherapy, especially in brain metastases patients after radiosurgical treatment.

Contrast-enhanced Magnetic Resonance Imaging of Brain Metastases at 7.0T versus 1.5T: A Preliminary Result

2015 ◽  
Vol 19 (1) ◽  
pp. 31
Author(s):  
Sun Ha Paek ◽  
Jhi-Hoon Kim ◽  
Sung-Hong Choi ◽  
Tae-Jin Yoon ◽  
Young Don Son ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Metastases ◽  
Resonance Imaging ◽  
Contrast Enhanced

Radiation Necrosis of the Optic Chiasm, Optic Tract, Hypothalamus, and Upper Pons after Radiotherapy for Pituitary Adenoma, Detected by Gadolinium-Enhanced, T1-Weighted Magnetic Resonance Imaging: Case Report

Neurosurgery ◽  
1990 ◽  
Vol 27 (4) ◽  
pp. 640-643 ◽  
Author(s):  
Osamu Tachibana ◽  
Narihito Yamaguchi ◽  
Tetsumori Yamashima ◽  
Junkoh Yamashita
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Radiation Necrosis ◽  
Optic Tract ◽  
Optic Chiasm ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Weighted Magnetic Resonance Imaging ◽  
Resonance Imaging Scan

Abstract A 26-year-old woman was treated for a prolactin secreting pituitary adenoma by surgery and radiotherapy (5860 rads). Fourteen months later, she developed right hemiparesis and dysarthria. A T1-weighted magnetic resonance imaging scan using gadolinium contrast showed a small, enhanced lesion in the upper pons. Seven months later, she had a sudden onset of loss of vision, and radiation optic neuropathy was diagnosed. A T1-weighted magnetic resonance imaging scan showed widespread gadolinium-enhanced lesions in the optic chiasm, optic tract, and hypothalamus. Magnetic resonance imaging is indispensable for the early diagnosis of radiation necrosis, which is not visualized by radiography or computed tomography.

Textiloma (Gossypiboma) Mimicking Recurrent Intracranial Tumor

2004 ◽  
Vol 128 (7) ◽  
pp. 749-758 ◽  
Author(s):  
Teresa Ribalta ◽  
Ian E. McCutcheon ◽  
Antonio G. Neto ◽  
Deepali Gupta ◽  
A. J. Kumar ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Foreign Bodies ◽  
Preoperative Magnetic Resonance Imaging ◽  
Hemostatic Agent ◽  
Recurrent Tumor ◽  
Resonance Imaging ◽  
Hemostatic Agents ◽  
Preoperative Magnetic Resonance ◽  
Mass Lesions

Abstract Context.—Resorbable substances used to achieve hemostasis during neurosurgical procedures comprise 3 principal classes based on chemical composition: (1) gelatin sponge, (2) oxidized cellulose, and (3) microfibrillar collagen. Nonresorbable hemostatic aides include various forms of cotton and rayon-based hemostats (cottonoids and kites). Resorbable and nonresorbable hemostatic agents have been reported to cause symptomatic mass lesions, most commonly following intra-abdominal surgery. Histologic examination typically shows a core of degenerating hemostatic agent surrounded by an inflammatory reaction. Each agent exhibits distinctive morphologic features that often permit specific identification. Hemostat-associated mass lesions have been variously referred to as textilomas, gossypibomas, gauzomas, or muslinomas. Objectives.—The aims of this study were to (1) identify cases of histologically proven cases of textiloma in neurosurgical operations, (2) characterize the specific hemostatic agent associated with textiloma formation, and (3) characterize the preoperative magnetic resonance imaging appearance of textiloma. Design.—Cases in which a textiloma constituted the sole finding on repeat surgery for recurrent brain tumor, or was a clinically significant component of a radiologically identified mass lesion together with residual tumor, constituted the study set. Results.—Five textilomas were identified and evaluated. The primary neoplasm was different in each case and included pituitary adenoma, tanycytic ependymoma, anaplastic astrocytoma, gliosarcoma, and oligodendroglioma. In all cases, preoperative magnetic resonance imaging suggested recurrent tumor. Textilomas included all categories of resorbable hemostatic agent. Other foreign bodies were present in some cases; the origin of these foreign bodies was traced to fibers shed from nonresorbable hemostatic material placed temporarily during surgery and removed before closure (cottonoids and kites). Inflammatory reactions included giant cells, granulomas, and fibroblastic proliferation. Microfibrillar collagen (Avitene) textilomas were associated with a striking eosinophil infiltration that was not seen with any other hemostatic agent. Conclusions.—Hemostatic agents may produce clinically symptomatic, radiologically apparent mass lesions. When considering a mass lesion arising after intracranial surgery, the differential diagnosis should include textiloma along with recurrent tumor and radiation necrosis.

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