Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis

Abstract

Rationale and Objectives To compare differences in diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrastenhanced (DSC) MR perfusion imaging characteristics of recurrent neoplasm and radiation necrosis in patients with brain tumors previously treated with radiotherapy with or without surgery and chemotherapy. Methods and Materials Patients with a history of brain neoplasm previously treated with radiotherapy with or without chemotherapy and surgery who developed a new enhancing lesion on post-treatment surveillance MRI were enrolled. DSC perfusion MR imaging and DTI were performed. Region of interest (ROI) cursors were manually drawn in the contrast enhancing lesions, in the perilesional white matter edema, and in the contralateral normal-appearing frontal lobe white matter. DTI and DSC perfusion MR indices were compared in recurrent tumor versus radiation necrosis. Results Twenty-two patients with 24 lesions were included. Sixteen (67%) lesions were placed into the recurrent neoplasm group and 8 (33%) were placed into the radiation necrosis group using biopsy results as the gold standard in all but 3 patients. Mean ADC values, mean parallel eigenvalues, and mean perpendicular eigenvalues in the contrast enhancing lesion were significantly lower and relative cerebral blood volume was significantly higher for the recurrent neoplasm group compared to the radiation necrosis group (p<0.01, p=0.03, p<0.01, and p<0.01 respectively). Conclusion The combined assessment of DTI and DSC MR perfusion properties of new contrast enhancing lesions is helpful in distinguishing recurrent neoplasm from radiation necrosis in patients with a history of brain neoplasm previously treated with radiotherapy with or without surgery and chemotherapy.

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

“…Some other chemotherapeutic treatments can also induce imaging abnormalities and an accurate distinction from relapse is therefore needed [ 76 ]. Several studies have addressed this clinical issue [ 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ]. As for the other previously presented outcomes, DSC has been more extensively investigated.…”

Clinical Applications of Contrast-Enhanced Perfusion MRI Techniques in Gliomas: Recent Advances and Current Challenges

“…The CBV threshold of 2.0 ml/100 g enabled the detection of regressing lesions with 100% sensitivity and 100% specificity. In addition, combined assessment using diffusion tensor imaging (ADC, mean parallel eigenvalues, and mean perpendicular eigenvalues) and DSC-MRI (rCBV) characteristics showed improved differentiation, particularly in the lesions with increased rCBV and decreased ADC values [ 186 ] ( Figure 6(b) ).…”

“…Corresponding rCBV and K trans maps show significant difference between these two entities, with higher K trans and rCBV for recurrent tumor (top row) but low for RN (bottom row) . Reproduce with permission from Bisdas et al [ 184 ] and Masch et al [ 186 ].…”

Machine Learning in Glioma Segmentation for Stereotactic Radiation Therapy Planning

“…В настоящее время в отечественной и зарубежной литературе появились работы, посвященные использованию методов молекулярной визуализации (ПЭТ, ОФЭКТ) и современных последовательностей МРТ (3D-спектроскопия, МР-диффузия и т.д.) для дифференциации продолженного роста и формирования объемов облучения [29,30].…”