Mario Muto1, Giulia Frauenfelder2, Rossana Senese3, Fabio Zeccolini1, Emiliano Schena4, Francesco Giurazza5, Hans Rolf Jäger6. 1. Department of Neuroradiology, AONR Cardarelli, Via Antonio Cardarelli, 9, 80100, Naples, Italy. 2. Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy. g.frauenfelder@unicampus.it. 3. Emicenter European Medical Imaging, Via Taverna Rossa, 169, 80020, Casavatore, Napoli, Italy. 4. Department of Measurement and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy. 5. Department of Interventional Radiology, AONR Cardarelli, Via Antonio Cardarelli, 9, 80100, Naples, Italy. 6. Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
Abstract
INTRODUCTION: Distinction between treatment-related changes and tumour recurrence in patients who have received radiation treatment for brain metastases can be difficult on conventional MRI. In this study, we investigated the ability of dynamic susceptibility contrast (DSC) perfusion in differentiating necrotic changes from pathological angiogenesis and compared measurements of relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and K2, using a dedicated software. METHODS: Twenty-nine patients with secondary brain tumors were included in this retrospective study and underwent DSC perfusion MRI with a 3-month follow-up imaging after chemo- or radiation-therapy. Region-of-interests were drawn around the contrast enhancing lesions and measurements of rCBV, rCBF and K2 were performed in all patients. Based on subsequent histological examination or clinico-radiological follow-up, the cohort was divided in two groups: recurrent disease and stable disease. Differences between the two groups were analyzed using the Student's t test. Sensitivity, specificity and diagnostic accuracy of rCBV measurements were analyzed considering three different cut-off values. RESULTS: Between patients with and without disease, only rCBV and rCBF values were significant (p < 0.05). The only cut-off value giving the best diagnostic accuracy of 100% was rCBV = 2.1 (sensitivity = 100%; specificity = 100%). Patients with tumor recurrence showed a higher mean value of rCBV (mean = 4.28, standard deviation = 2.09) than patients with necrotic-related changes (mean = 0.77, standard deviation = 0.44). CONCLUSION: DSC-MRI appears a clinically useful method to differentiate between tumor recurrence, tumor necrosis and pseudoprogression in patients treated for cerebral metastases. Relative CBV using a cut-off value of 2.1 proved to be the most accurate and reliable parameter.
INTRODUCTION: Distinction between treatment-related changes and tumour recurrence in patients who have received radiation treatment for brain metastases can be difficult on conventional MRI. In this study, we investigated the ability of dynamic susceptibility contrast (DSC) perfusion in differentiating necrotic changes from pathological angiogenesis and compared measurements of relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and K2, using a dedicated software. METHODS: Twenty-nine patients with secondary brain tumors were included in this retrospective study and underwent DSC perfusion MRI with a 3-month follow-up imaging after chemo- or radiation-therapy. Region-of-interests were drawn around the contrast enhancing lesions and measurements of rCBV, rCBF and K2 were performed in all patients. Based on subsequent histological examination or clinico-radiological follow-up, the cohort was divided in two groups: recurrent disease and stable disease. Differences between the two groups were analyzed using the Student's t test. Sensitivity, specificity and diagnostic accuracy of rCBV measurements were analyzed considering three different cut-off values. RESULTS: Between patients with and without disease, only rCBV and rCBF values were significant (p < 0.05). The only cut-off value giving the best diagnostic accuracy of 100% was rCBV = 2.1 (sensitivity = 100%; specificity = 100%). Patients with tumor recurrence showed a higher mean value of rCBV (mean = 4.28, standard deviation = 2.09) than patients with necrotic-related changes (mean = 0.77, standard deviation = 0.44). CONCLUSION: DSC-MRI appears a clinically useful method to differentiate between tumor recurrence, tumor necrosis and pseudoprogression in patients treated for cerebral metastases. Relative CBV using a cut-off value of 2.1 proved to be the most accurate and reliable parameter.
Authors: Meng Law; Sarah Oh; Glyn Johnson; James S Babb; David Zagzag; John Golfinos; Patrick J Kelly Journal: Neurosurgery Date: 2006-06 Impact factor: 4.654
Authors: Michael H Lev; Yelda Ozsunar; John W Henson; Amjad A Rasheed; Glenn D Barest; Griffith R Harsh; Markus M Fitzek; E Antonio Chiocca; James D Rabinov; Andrew N Csavoy; Bruce R Rosen; Fred H Hochberg; Pamela W Schaefer; R Gilberto Gonzalez Journal: AJNR Am J Neuroradiol Date: 2004-02 Impact factor: 3.825
Authors: S Cha; J M Lupo; M-H Chen; K R Lamborn; M W McDermott; M S Berger; S J Nelson; W P Dillon Journal: AJNR Am J Neuroradiol Date: 2007 Jun-Jul Impact factor: 3.825
Authors: Balamurugan A Vellayappan; Tresa McGranahan; Jerome Graber; Lynne Taylor; Vyshak Venur; Richard Ellenbogen; Andrew E Sloan; Kristin J Redmond; Matthew Foote; Samuel T Chao; John H Suh; Eric L Chang; Arjun Sahgal; Simon S Lo Journal: Curr Treat Options Oncol Date: 2021-06-07