scholarly journals OS3 - 187 Differentiating Radionecrosis from Tumor Progression Using IVIM perfusion Fraction in Brain Metastases Treated with Radiosurgery

2016 ◽  
Vol 43 (S4) ◽  
pp. S2-S2
Author(s):  
J Detsky ◽  
J Conklin ◽  
J Keith ◽  
S Symons ◽  
A Sahgal ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Progression ◽  
Gold Standard ◽  
Diffusion Weighted Imaging ◽  
Radiation Necrosis ◽  
The Other ◽  
Recurrent Tumor ◽  
Perfusion Fraction ◽  
The Mean ◽  
Pathology Reports

Radiation necrosis occurs in 5-25% of patients who undergo stereotactic radiosurgery (SRS) for brain metastases. Intravoxel incoherent motion (IVIM) uses MRI diffusion-weighted imaging (DWI) to assess regional perfusion. We investigated the utility of IVIM to differentiate recurrent tumor from radionecrosis after SRS. Patients who had SRS and subsequent surgical resection of what was thought to be either tumor progression or necrosis were included. ROIs were contoured on the pre-operative post-Gd T1-weighted images and transferred to DWI images using automated co-registration. The perfusion fraction (f) was calculated using asymptotic fitting and the mean f (fmean), 90th percentile for f (f90), mean ADC (ADCmean) and 10th percentile for ADC (ADC10) were calculated. Pathology reports were used to identify the predominant feature (necrosis versus tumor). Nine patients with ten lesions were included. One lesion exhibited pure necrosis while the other nine were mixed; three were predominantly (>75%) tumor, three predominantly necrosis, and three were equal parts of both. The perfusion fraction was significantly higher in cases with predominantly tumor compared to those with predominantly necrosis (fmean 0.10±0.01 vs 0.08±0.01, p=0.02 and f90 0.22±0.01 vs 0.14±0.02, p<0.001). ADC did not differentiate tumor from necrosis (ADCmean 0.97±0.23 vs 1.02±0.36, p=0.8 and ADC10 0.53±0.29 vs 0.76±0.29, p=0.33). The IVIM perfusion fraction is useful in differentiating recurrent tumor from radionecrosis in brain metastases treated with SRS. This is the first study to evaluate IVIM against the gold standard (histopathology).

scholarly journals SURG-06. LASER INTERSTITIAL THERMAL THERAPY COMPARED TO CRANIOTOMY FOR TREATMENT OF RADIATION NECROSIS OR RECURRENT TUMOR IN BRAIN METASTASES FAILING RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i31-i32
Author(s):  
Christopher Hong ◽  
Di Deng ◽  
Nanthiya Sujijantarat ◽  
Alberto Vera ◽  
Veronica Chiang
Keyword(s):  
Brain Metastases ◽  
Radiation Necrosis ◽  
Symptom Relief ◽  
Group Analysis ◽  
Progression Free Survival ◽  
Thermal Therapy ◽  
Recurrent Tumor ◽  
Laser Interstitial Thermal Therapy ◽  
Neurological Outcomes ◽  
Significant Difference

Abstract Many publications report laser-interstitial thermal therapy (LITT) as a viable alternative treatment to craniotomy for radiation necrosis (RN) and re-growing tumor occurring after stereotactic radiosurgery (SRS) for brain metastases. No studies to-date have compared the two options. The aim of this study was to retrospectively compare outcomes after LITT versus craniotomy for regrowing lesions in patients previously treated with SRS for brain metastases. Data were collected from a single-institution chart review of patients treated with LITT or craniotomy for previously irradiated brain metastasis. Of 75 patients, 42 had recurrent tumor (56%) and 33 (44%) had RN. Of patients with tumor, 26 underwent craniotomy and 16 LITT. For RN, 15 had craniotomy and 18 LITT. There was no significant difference between LITT and craniotomy in ability to taper off steroids or neurological outcomes. Progression-free survival (PFS) and overall survival (OS) were similar for LITT versus craniotomy, respectively: %PFS-survival at 1-year = 72.2% versus 61.1%, %PFS-survival at 2-years = 60.0% versus 61.1%, p = 0.72; %OS-survival at 1-year = 69.0% versus 69.3%, %OS-survival at 2-years = 56.6% versus 49.5%, p = 0.90. This finding persisted on sub-analysis of smaller lesions under &lt; 3cm in diameter. Craniotomy resulted in higher rates of pre-operative deficit improvement than LITT (p &lt; 0.01). On sub-group analysis, the single factor most significantly associated with OS and PFS was pathology of the lesion. About 40% of tumor lesions needed post-operative salvage with radiation after both craniotomy and LITT. LITT was as efficacious as craniotomy in achieving local control of recurrent irradiated brain metastases and facilitating steroid taper, regardless of pathology. Craniotomy appears to be more advantageous for providing symptom relief in those with pre-operative symptoms.

scholarly journals Novel biomarker identification using metabolomic profiling to differentiate radiation necrosis and recurrent tumor following Gamma Knife radiosurgery

2017 ◽  
Vol 127 (2) ◽  
pp. 388-396 ◽  
Author(s):  
Alex Y. Lu ◽  
Jack L. Turban ◽  
Eyiyemisi C. Damisah ◽  
Jie Li ◽  
Ahmed K. Alomari ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Radiation Necrosis ◽  
Imaging Techniques ◽  
Statistical Significance ◽  
Gamma Knife Radiosurgery ◽  
Metabolic Imaging ◽  
Management Decision ◽  
Recurrent Tumor ◽  
Metabolite Profiles

OBJECTIVEFollowing an initial response of brain metastases to Gamma Knife radiosurgery, regrowth of the enhancing lesion as detected on MRI may represent either radiation necrosis (a treatment-related inflammatory change) or recurrent tumor. Differentiation of radiation necrosis from tumor is vital for management decision making but remains difficult by imaging alone. In this study, gas chromatography with time-of-flight mass spectrometry (GC-TOF) was used to identify differential metabolite profiles of the 2 tissue types obtained by surgical biopsy to find potential targets for noninvasive imaging.METHODSSpecimens of pure radiation necrosis and pure tumor obtained from patient brain biopsies were flash-frozen and validated histologically. These formalin-free tissue samples were then analyzed using GC-TOF. The metabolite profiles of radiation necrosis and tumor samples were compared using multivariate and univariate statistical analysis. Statistical significance was defined as p ≤ 0.05.RESULTSFor the metabolic profiling, GC-TOF was performed on 7 samples of radiation necrosis and 7 samples of tumor. Of the 141 metabolites identified, 17 (12.1%) were found to be statistically significantly different between comparison groups. Of these metabolites, 6 were increased in tumor, and 11 were increased in radiation necrosis. An unsupervised hierarchical clustering analysis found that tumor had elevated levels of metabolites associated with energy metabolism, whereas radiation necrosis had elevated levels of metabolites that were fatty acids and antioxidants/cofactors.CONCLUSIONSTo the authors' knowledge, this is the first tissue-based metabolomics study of radiation necrosis and tumor. Radiation necrosis and recurrent tumor following Gamma Knife radiosurgery for brain metastases have unique metabolite profiles that may be targeted in the future to develop noninvasive metabolic imaging techniques.

scholarly journals The centrally restricted diffusion sign on MRI for assessment of radiation necrosis in metastases treated with stereotactic radiosurgery

2021 ◽  
Author(s):  
Nicolin Hainc ◽  
Noor Alsafwani ◽  
Andrew Gao ◽  
Philip J. O’Halloran ◽  
Paul Kongkham ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Interobserver Agreement ◽  
Radiation Necrosis ◽  
Restricted Diffusion ◽  
Post Contrast ◽  
Primary Tumors ◽  
Increased Susceptibility ◽  
Subsequent Intervention

Abstract Purpose Differentiation of radiation necrosis from tumor progression in brain metastases treated with stereotactic radiosurgery (SRS) is challenging. For this, we assessed the performance of the centrally restricted diffusion sign. Methods Patients with brain metastases treated with SRS who underwent a subsequent intervention (biopsy/resection) for a ring-enhancing lesion on preoperative MRI between 2000 and 2020 were included. Excluded were lesions containing increased susceptibility limiting assessment of DWI. Two neuroradiologists classified the location of the diffusion restriction with respect to the post-contrast T1 images as centrally within the ring-enhancement (the centrally restricted diffusion sign), peripherally correlating to the rim of contrast enhancement, both locations, or none. Measures of diagnostic accuracy and 95% CI were calculated for the centrally restricted diffusion sign. Cohen's kappa was calculated to identify the interobserver agreement. Results Fifty-nine patients (36 female; mean age 59, range 40 to 80) were included, 36 with tumor progression and 23 with radiation necrosis based on histopathology. Primary tumors included 34 lung, 12 breast, 5 melanoma, 3 colorectal, 2 esophagus, 1 head and neck, 1 endometrium, and 1 thyroid. The centrally restricted diffusion sign was seen in 19/23 radiation necrosis cases (sensitivity 83% (95% CI 63 to 93%), specificity 64% (95% CI 48 to 78%), PPV 59% (95% CI 42 to 74%), NPV 85% (95% CI 68 to 94%)) and 13/36 tumor progression cases (difference p < 0.001). Interobserver agreement was substantial, at 0.61 (95% CI 0.45 to 70.8). Conclusion We found a low probability of radiation necrosis in the absence of the centrally restricted diffusion sign.

Imaging changes over 18 months following stereotactic radiosurgery for brain metastases: both late radiation necrosis and tumor progression can occur

2017 ◽  
Vol 136 (1) ◽  
pp. 207-212 ◽  
Author(s):  
Dylann Fujimoto ◽  
Rie von Eyben ◽  
Iris C. Gibbs ◽  
Steven D. Chang ◽  
Gordon Li ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis
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