Radiological progression of cerebral metastases after radiosurgery: assessment of perfusion MRI for differentiating between necrosis and recurrenceReport as inadecuate




Radiological progression of cerebral metastases after radiosurgery: assessment of perfusion MRI for differentiating between necrosis and recurrence - Download this document for free, or read online. Document in PDF available to download.

Journal of Neurology

, 256:878

First Online: 10 March 2009Received: 26 May 2008Revised: 03 November 2008Accepted: 19 November 2008

Abstract

To assess the capability of perfusion MRI to differentiate between necrosis and tumor recurrence in patients showing radiological progression of cerebral metastases treated with stereotactic radiosurgery SRS.
From 2004 to 2006 dynamic susceptibility-weighted contrast-enhanced perfusion MRI scans were performed on patients with cerebral metastasis showing radiological progression after SRS during follow-up.
Several perfusion MRI characteristics were examined: a subjective visual score of the relative cerebral blood volume rCBV map and quantitative rCBV measurements of the contrast-enhanced areas of maximal perfusion.
For a total of 34 lesions in 31 patients a perfusion MRI was performed.
Diagnoses were based on histology, definite radiological decrease or a combination of radiological and clinical follow-up.
The diagnosis of tumor recurrence was obtained in 20 of 34 lesions, and tumor necrosis in 14 of 34.
Regression analyses for all measures proved statistically significant χ = 11.6–21.6, P < 0.001–0.0001.
Visual inspection of the rCBV map yielded a sensitivity and specificity of 70.0 respectively 92.9%.
The optimal cutoff point for maximal tumor rCBV relative to white matter was 2.00 improving the sensibility to 85.0% and 1.85 relative to grey matter GM, improving the specificity to 100%, with a corresponding sensitivity of 70.0%.
Perfusion MRI seems to be a useful tool in the differentiation of necrosis and tumor recurrence after SRS.
For the patients displaying a rCBV-GM greater than 1.85, the diagnosis of necrosis was excluded.
Salvage treatment can be initiated for these patients in an attempt to prolong survival.

KeywordsCerebral metastases Stereotactic radiosurgery Perfusion MRI Necrosis Recurrence  Download fulltext PDF



Author: Friso W. A. Hoefnagels - Frank J. Lagerwaard - Esther Sanchez - Cornelis J. A. Haasbeek - Dirk L. Knol - Ben J. Slotm

Source: https://link.springer.com/



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