Serial diffusion-weighted magnetic resonance imaging in cases of glioma: distinguishing tumor recurrence from postresection injury
| Autor: | Susan M. Chang, Andrew T. Parsa, Soonmee Cha, Mitchel S. Berger, Mary Catherine Mayo, William P. Dillon, Justin S. Smith, Michael W. McDermott |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Sensitivity and Specificity Diagnosis Differential Central nervous system disease Postoperative Complications Neuroimaging Glioma medicine Humans Prospective Studies Prospective cohort study Aged medicine.diagnostic_test Brain Neoplasms business.industry Neurooncology Magnetic resonance imaging Middle Aged medicine.disease Tumor recurrence Diffusion Magnetic Resonance Imaging Disease Progression Female Neoplasm Recurrence Local Nuclear medicine business Diffusion MRI |
| Zdroj: | Journal of Neurosurgery. 103:428-438 |
| ISSN: | 0022-3085 |
| DOI: | 10.3171/jns.2005.103.3.0428 |
| Popis: | Object Diffusion-weighted magnetic resonance (MR) imaging is an invaluable tool in the diagnosis of acute stroke and other types of brain injury. Abnormalities in and around the resection cavity on diffusion-weighted imaging have been observed following surgery for infiltrating glioma. The purpose of this study was to investigate prospectively the incidence, time course, and ultimate outcome of these abnormalities. Methods Forty-four consecutive patients with newly diagnosed gliomas were prospectively observed using serial MR imaging including diffusion-weighted sequences. Clinical and surgical data were also collected. Immediately postoperatively neuroimaging identified 28 patients (64%) in whom areas of reduced diffusion appeared in or around the resection cavity (mean volume 8.2 ± 1.5 cm3). Complete resolution of this reduced diffusion was demonstrated within 90 days in 24 patients (86%). On subsequent neuroimages these areas demonstrated Gd enhancement as early as postoperative Day 15 and as late as Day 198 and ultimately took on the appearance of encephalomalacia in 26 (93%) of 28 cases. Postoperative reduced diffusion was not predicted by the clinical or surgical parameters that were assessed. No clinical deficits were attributable to the reduced diffusion. Conclusions An abnormality related to diffusion-weighted sequences on postoperative MR imaging can occur after resection of newly diagnosed gliomas. In this study the abnormality typically resolved and was replaced by contrast enhancement on follow-up imaging, ultimately demonstrating encephalomalacia on long-term follow up. Findings on neuroimaging during the period of enhancement could be confused with recurrent tumor and interpreted as early treatment failure. Based on the findings of this study the authors strongly suggest that the inclusion of diffusion-weighted sequences in postoperative MR imaging is essential, as is MR imaging immediately before radiation therapy to monitor disease progression. A new enhancement observed after glioma surgery should be interpreted in the context of the diffusion-weighted image obtained immediately postoperatively. |
| Databáze: | OpenAIRE |
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