Glioma Recurrence Versus Radiation Necrosis?
| Autor: | Kenneth K. Kwong, Michael H. Lev, Christine Ament, Fred H. Hochberg, Yelda Ozsunar, Pamela W. Schaefer, R. Gilberto Gonzalez, Mark E. Mullins |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Necrosis medicine.diagnostic_test business.industry medicine.medical_treatment Magnetic resonance imaging Blood volume Glial tumor medicine.disease Radiation therapy Positron emission tomography Glioma medicine Radiology Nuclear Medicine and imaging Radiology medicine.symptom business Nuclear medicine Perfusion circulatory and respiratory physiology |
| Zdroj: | Academic Radiology. 17:282-290 |
| ISSN: | 1076-6332 |
| DOI: | 10.1016/j.acra.2009.10.024 |
| Popis: | Rationale and Objectives Distinguishing recurrent glial tumor from radiation necrosis can be challenging. The purpose of this pilot study was to preliminarily compare unenhanced arterial spin-labeled (ASL) imaging, dynamic susceptibility contrast-enhanced cerebral blood volume (DSCE-CBV) magnetic resonance imaging, and positron emission tomographic (PET) imaging in distinguishing predominant glioma recurrence or progression from predominant radiation necrosis in postoperative patients treated with proton-beam therapy. Methods Patients with grade II to IV glioma previously treated with surgery and proton-beam therapy were enrolled on the basis of new enhancing nodules or masses with primary differential diagnoses of predominant tumor recurrence or progression versus radiation necrosis. ASL, DSCE-CBV, and PET examinations were assessed by visual qualitative and quantitative analysis for the detection of predominant tumor recurrence. Imaging results were correlated with a clinical-pathologic reference standard. Results Thirty patients were studied, resulting in 33 ASL, 32 DSCE-CBV, and 26 PET examinations. On the basis of visual inspection, the sensitivities of PET, ASL, and DSCE-CBV examinations for detecting high-grade tumor foci were 81%, 88%, and 86%, respectively. The highest sensitivity values for quantitative ASL imaging were obtained using a normalized cutoff ratio of 1.3, resulting in sensitivity of 94% for ASL imaging and 71% for DSCE-CBV imaging. When predominant high-grade tumors with superimposed regions of predominant mixed radiation necrosis were excluded, DSCE-CBV sensitivity improved to 90%, but ASL sensitivity remained unchanged. Conclusions Compared with DSCE-CBV imaging, ASL imaging may more accurately distinguish predominant recurrent high-grade glioma from radiation necrosis, especially in regions with mixed radiation necrosis, for which DSCE-CBV imaging may underestimate true blood volume because of leakage artifacts. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|