Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis

Taylor, Judy; Langston, J. William; Reddick, Wilburn E.; Kingsley, Peter B.; Ogg, Robert J.; Pui, Margaret H.; Kun, Larry E.; Jenkins, Jesse J.; Chen, Gang; Ochs, Judith; Sanford, Robert A.; Heideman, Richard L.

doi:10.1016/s0360-3016(96)00376-8

Cited by 114 publications

(45 citation statements)

References 39 publications

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“…In necrosis, CHO, CR, and NA are reduced. MR spectroscopy correctly identified five of seven cases of active tumor and four of five cases of cerebral necrosis [23]. Again, a larger study is necessary to determine the role of MR spectroscopy in distinguishing recurrent tumor versus radiation necrosis.…”

Section: Discussionmentioning

confidence: 91%

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

331

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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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Section: Discussionmentioning

confidence: 91%

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

331

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“…Proton MR spectroscopy (PMRS) appears to be a valuable tool for differentiating recurrent tumor from radiation necrosis 25,26 . The study by Weybright and colleagues 26 using 2D Chemical shift magnetic resonance (MR) spectroscopy on 16 patients with active tumors and 12 patients with radiation injuries, showed that the Chol/Cr and Chol/NAA ratios were significantly higher, and the NAA/Cr ratio was significantly lower in tumor than in radiation injury.…”

Section: Discussionmentioning

confidence: 99%

Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

Korchi

Garibotto

Lövblad

et al. 2013

Can. J. Neurol. Sci.

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Proton beam therapy (PBT) is used for the treatment of skull base tumors to precisely deliver high-doses of radiation to the tumor volume while sparing normal brain tissue and other organs at risk such as the optic apparatus, the brainstem and the pituitary gland. It offers superior dose distribution as compared to photon radiation therapy. The clinical advantage of PBT over photon techniques is the marked reduction in the integral dose to the patient due to the absence of an exit dose beyond the proton Bragg peak. Proton beam therapy has shown benefits in the treatment of skull base tumors, uveal melanoma, optic pathway gliomas, pituitary adenomas, acoustic neuromas, nasopharynx and paranasal sinus tumors and spinal cord tumors. [1][2][3][4] . A rare yet important complication following brain radiation therapy is radiation necrosis 5-7 , i.e. the appearance of a new ABSTRACT: Background: Discrimination between radiation necrosis and tumor progression after radiation therapy represents a radiologic challenge. The aim of our investigation is to identify patterns of radiation necrosis on brain magnetic resonance imaging (MRI) and positron emission tomography (PET) with Fluoroethyltyrosin (FET) after proton beam therapy (PBT) for skull base tumors. Material and Methods:Five consecutive patients with extra-axial neoplasms were included, presenting a total of eight radiation necrosis lesions (three clival chordomas; two petroclival chondrosarcomas; two women; mean age: 49 ± 18.2 years). Radiation necrosis was defined as the appearance of abnormal enhancement on MRI after PBT decreasing over time, and additional histopathologic confirmation in one patient. MRI and PET imaging were retrospectively analyzed by two experienced radiologists in consensus. Results: All lesions were localized close to the primary tumor in the field of irradiation. Three patients showed bilateral symmetrical lesions. All lesions showed T2 hyperintensity and T1 hypointensity. Cerebral blood volume (CBV) was reduced in all available studies. None of the lesions showed a restricted diffusion. FET-PET (three patients) showed a higher uptake in four out of five lesions; three of which had a mean tumor-to-background (TBRmean) uptake lower than 1.95 and FET uptake increasing over time and were correctly classified into radiation necrosis. Conclusions: Most radiation necroses were in direct continuity with the primary tumor mimicking tumor progression. The most consistent imaging findings for PBT radiation necrosis are low CBV without restricted diffusion and FET-PET TBRmean lower than 1.95 or increasing uptake over time. Bilateral symmetric involvement may be another indicator of radiation necrosis.RÉSUMÉ: Critères radiologiques de la nécrose après protonthérapie des tumeurs de la base du crâne. Contexte : La distinction entre la nécrose due à l'irradiation et la progression de la tumeur après l'irradiation est un défi au point de vue radiologique. Le but de notre étude était d'identifier le profil radiologique de la nécrose radio-induite à l'IRM et...

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“…Estudios que se han hecho para tratar de aclarar el diagnóstico entre recidiva tumoral y efectos post-tratamiento con radiación han encontrado que como contrapartida a un mayor índice de supervivencia de los pacientes con tumores cerebrales existe con gran frecuencia lesión cerebral post-radioterapia consistente especialmente en necrosis perilesional tardía progresiva en al menos el 50% de los casos después de radiocirugía y del 65% en casos de radioterapia intersticial. Las técnicas de PET-FDG han probado ser las más apropiadas y exactas para este tipo de diagnóstico diferencial porque permite apreciar la ausencia de metabolismo y falta de captación de la glucosa, compatibles con radionecrosis (7,8,36) . Se pueden observar dos tipos de efectos postradioterapia, uno es el daño en el tejido glial que aunque se trate con corticoterapia no mejora el pronóstico para el paciente, y el otro, son los efectos tardíos que presentan el reto para la clínica diaria de diferenciar entre la recurrencia tumoral y la radionecrosis lo que sí tendría diferente pronóstico.…”

Section: Efectos De La Irradiaciónunclassified

“…Estas alteraciones se reflejan en diversos déficits neuropsicológicos, especialmente en atención, velocidad de procesamiento, memoria y funciones ejecutivas, afectando la calidad de vida de los supervivientes (3)(4)(5) . Se han estudiado los efectos de la quimioterapia y la radioterapia sobre el tejido cerebral y el funcionamiento cognitivo posteriores a la resección de tumores cerebrales por esos métodos [6][7][8][9] , en pacientes con cáncer del seno (10)(11)(12)(13)(14) , de testículos y de ovario (15,16) , y otros de cáncer de pulmón (17) , en los que los pacientes han desarrollado cambios en sus funciones mentales seguidos al tratamiento de quimio y radioterapia, o a la combinación de los dos. También se han visto casos infantiles de leucemia o de neoplasias cerebrales tratados con radiación en que se afectan las funciones cognitivas y el desarrollo (por disfunción endocrina) (18,19) .…”

Section: Introductionunclassified

Déficits neuropsicológicos asociados a alteraciones cerebrales secundarias a tratamiento oncológicos

Gómez-Cruz¹

2012

Psicooncología

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ResumenGracias a recientes avances en cirugía, radiación y farmacología se está incrementando la tasa de supervivencia al cáncer pero cada vez es más frecuente encontrar personas que presentan alteraciones cognitivas y comportamentales posteriores a tratamientos de quimioterapia y radioterapia. Estas alteraciones pueden relacionarse con lesiones causadas al tejido cerebral, especialmente a la sustancia blanca, por tales tratamientos oncológicos. En este trabajo se exponen los procesos neurobiológicos que subyacen a los mencionados défi-cits neuropsicológicos, como son la inhibición de la neurogénesis del hipocampo, la destrucción de los precursores de oligodendrocitos y los cambios producidos en la sustancia blanca. Se examina de qué manera todo ello se expresa en la forma de fallas en atención, velocidad de procesamiento de la información, memoria, y funciones ejecutivas.Palabras clave: Cáncer. Déficits cognitivos. Leucoencefalopatía. Neurogénesis. Quimioterapia. Radioterapia. Sustancia blanca. AbstractRecent advances in surgery, radiation and pharmacology have brought an increase on the rate of survival from cancer. However, it is frequent to see patients affected by cognitive impairments and behavioral changes after chemotherapy and radiology treatments. These changes might be related to injury to the brain tissue, especially to the white matter, caused by such oncological therapies. This work examines the neurobiological processes that underlie the mentioned neuropsychological impairments, such as the hippocampal neurogenesis inhibition, the destruction of oligodendrocytes precursors, as well as changes in white matter. Cognitive dysfunction sequelae in the form of deficits on attention, speed of information processing, memory, and executive functions are also studied.

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Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis

Cited by 114 publications

References 39 publications

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

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

Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

Déficits neuropsicológicos asociados a alteraciones cerebrales secundarias a tratamiento oncológicos

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