Brain radiation lesions: MR imaging.

Dooms, Grégoire; Hecht, Stephen T.; Brant‐Zawadzki, Michael; Berthiaume, Yves; Norman, David; Newton, Thomas H.

doi:10.1148/radiology.158.1.3940373

Cited by 235 publications

(83 citation statements)

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“…Our quantitative protocol is readily translatable to the clinical context. MRI descriptions of cranial radiation-induced lesions have been identified as increased T2WI signals in brain tissue (7)(8)(9)25). However, T2 relaxation times are the dominant feature of T2W images; thus, irradiation-induced early increases in T2 values can occur sooner than visible T2WI lesions (8,9).…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging assessment of memory‐related brain structures in a rat model of acute space‐like radiation

Huang¹,

Smith²,

Cummings³

et al. 2009

Magnetic Resonance Imaging

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Purpose: To investigate the acute effects on the central nervous system (CNS) of 56 Fe radiation, a component of high-energy charged particles (HZE) in space radiation, using quantitative magnetic resonance imaging (MRI) noninvasively. Materials and Methods:Sprague-Dawley rats were exposed to whole-brain 56 Fe (0, 1, 2, and 4 Gy). At 1 week postirradiation, MRI scans were made using T2-weighted (T2WI), diffusion-weighted (DWI), and contrast enhanced T1-(CET1) imaging. T2 relaxation time and apparent diffusion coefficient (ADC) values were obtained from memoryrelated brain regions of interest (ROIs). Histopathology was correlated using ex vivo tissues. Results:No overt abnormalities were visualized using T2WI and DWI at 1 week postradiation. CET1 values did not differ significantly between the irradiated and control animals. Compared to 0 Gy, there were significant prolongations in T2 values and reductions in ADC after irradiation. In the absence of evident neuronal pathology, immunohistochemistry revealed astrocytic activation in 4 Gy animals. Conclusion:At 1 week after whole-brain 56 Fe exposure, T2 and ADC values can differentiate radiosensitivity in regions critical for hippocampal-related memory. MRI may provide noninvasive assessment of the initial molecular/cellular disturbances in vivo after HZE irradiation.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging assessment of memory‐related brain structures in a rat model of acute space‐like radiation

Huang¹,

Smith²,

Cummings³

et al. 2009

Magnetic Resonance Imaging

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“…Treatment is further confounded by the clinical and radiographic impossibility of distinguishing AIRS from the most feared eventuality in patients with previously-treated brain tumors: recurrence [12][13][14][15]. Both possibilities are commonly encountered -AIRS typically manifests between three months and several years following SRS [14], with an incidence is as high as 50% at treatment doses between 16 and 22Gy to the tumor margin [16][17][18]; local recurrence after SRS is as high as 18% at one-year follow-up [19] and increases to 31% at two years [20].…”

Section: Introductionmentioning

confidence: 99%

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Tsvankin¹,

Howell²,

Fecci³

2017

JNSK

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Brain metastases are the most common type of intracranial tumor, and confer a dismal prognosis. Morbidity in these patients arises not only from tumor burden but from treatment-related toxicities. Among the most significant of these is radiation necrosis, a common sequelae of stereotactic radiosurgery that may cause neurologic impairment through mass effect or steroid-refractory edema. Truly, "radiation necrosis" is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). Because it is impossible to reliably distinguish AIRS from tumor recurrence without a biopsy, and because high-dose steroids are poorly tolerated, management of AIRS poses a significant therapeutic challenge. Laser interstitial thermal therapy (LITT) is an emerging minimally-invasive treatment modality which uses hyperthermia to ablate intracranial pathologic tissues. Here, we describe the use of LITT in a patient with steroid-refractory AIRS following radiosurgery for a right supplementary motor area metastatic focus, and provide a brief review of the utility of LITT in patients with AIRS. direct heat application across the lesion volume, resulting in controlled cell death [30]. In contrast to open surgery, LITT can be performed through the same basic operating platform as a biopsy, allowing the neurosurgeon to avoid the risk of performing a craniotomy. The incision is less than 1cm long; at our institution, patients do not require ICU admission postoperatively, and most are discharged either the same day or the following morning. The result is a minimally-morbid diagnostic and treatment option for patients with previously-treated intracranial tumors. Here, we offer an illustrative case and brief review of LITT application in the setting of AIRS. Citation Case ReportThe patient is a 66 year old right-handed female with a history of lung adenocarcinoma, initially diagnosed in January of 2014 when she presented with cough and hemoptysis. Surveillance imaging demonstrated a solitary 1cm metastasis of the right frontal lobe, and the patient was treated with Cyber Knife on 3/5/2014. She underwent concurrent chemoradiation with carboplatin/paclitaxel and 60Gy radiation to the right upper lung, mediastinum and SCV region (completed 4/16/2014), followed by an additional two cycles of chemotherapy (completed 5/20/2014). She was subsequently placed on erlotinib due to EGFR mutation, then switched to afatenib in September 2014.In July 2015 the patient noted a sense of imbalance and left hand weakness; an MRI demonstrated enlargement of the previously-treated brain metastasis at the posterior margin of the right superior frontal gyrus, with significant associated edema (Figure 1). She was started on dexamethasone, with some symptomatic improvement. Given her continued weakness, however, a plan was made for the patient to undergo stereotactic biopsy with possible subsequent LITT.On 10/12/2015 the patient was electively taken to the operating room. Using frameless stereotaxy, a biopsy was...

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“…Neither computed tomography (CT) nor magnetic resonance imaging (MRI) scans can distinguish between recurrent tumor and radionecrosis because both lesions demonstrate mass effect and contrast enhancement [2][3][4]. Other non-invasive modalities that have been used to differentiate the two are positron emission tomography (PET), single photon emission computerized tomography (SPECT), and magnetic resonance (MR) spectroscopy.…”

Section: Introductionmentioning

confidence: 99%

The sensitivity and specificity of FDG PET in distinguishing recurrent brain tumor from radionecrosis in patients treated with stereotactic radiosurgery

Chao

Suh

Raja

et al. 2001

Intl Journal of Cancer

333

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SUMMARY Radiation necrosis and recurrent brain tumor have similar symptoms and are indistinguishable on both magnetic resonance imaging (MRI) and computed tomograph scans.18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been proposed as a diagnostic alternative, particularly when co-registered with MRI. We studied 47 patients with brain tumors treated with stereotactic radiosurgery and followed with FDG PET. For all tumor types, the sensitivity of FDG PET for diagnosing tumor was 75% and the specificity was 81%. For brain metastasis without MRI co-registration, FDG PET had a sensitivity of 65% and a specificity of 80%. For brain metastasis with MRI co-registration, FDG PET had a sensitivity of 86% and specificity of 80%. MRI coregistration appears to improve the sensitivity of FDG PET, making it a useful modality to distinguish between radiation necrosis and recurrent brain metastasis.

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Brain radiation lesions: MR imaging.

Cited by 235 publications

References 0 publications

Neuroimaging assessment of memory‐related brain structures in a rat model of acute space‐like radiation

Neuroimaging assessment of memory‐related brain structures in a rat model of acute space‐like radiation

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

The sensitivity and specificity of FDG PET in distinguishing recurrent brain tumor from radionecrosis in patients treated with stereotactic radiosurgery

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