Differentiation between intra-axial metastatic tumor progression and radiation injury following fractionated radiation therapy or stereotactic radiosurgery using MR spectroscopy, perfusion MR imaging or volume progression modeling

Huang, Jiayi; Wang, Ay Ming; Shetty, Anil N.; Maitz, Ann; Yan, Di; Doyle, Danielle; Richey, Kenneth; Park, Sean S.; Pieper, Daniel R.; Chen, Peter Y.; Grills, I.S.

doi:10.1016/j.mri.2011.04.004

Cited by 66 publications

(74 citation statements)

References 20 publications

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“…Other advanced imaging techniques such as hyperperfusion fractioning, volume modeling, MRI spectroscopy, diffusion tensor imaging, and positron emission tomography/computed tomography have been used to identify radiation necrosis with promising results [35–42]. Unfortunately, however, these techniques have not been validated in large clinical trials or in comparative effectiveness research.…”

Section: Discussionmentioning

confidence: 99%

MRI perfusion in determining pseudoprogression in patients with glioblastoma

Young¹,

Gupta²,

Shah³

et al. 2013

Clinical Imaging

129

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We examine the role of dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) perfusion in differentiating pseudoprogression from progression in 20 consecutive patients with treated glioblastoma. MRI perfusion was performed, and relative cerebral blood volume (rCBV), relative peak height (rPH), and percent signal recovery (PSR) were measured. Pseudoprogression demonstrated lower median rCBV (P=.009) and rPH (P<.001), and higher PSR (P=.039) than progression. DSC MRI perfusion successfully identified pseudoprogression in patients who did not require a change in treatment despite radiographic worsening following chemoradiotherapy.

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Section: Discussionmentioning

confidence: 99%

MRI perfusion in determining pseudoprogression in patients with glioblastoma

Young¹,

Gupta²,

Shah³

et al. 2013

Clinical Imaging

129

View full text Add to dashboard Cite

show abstract

“…A prospective study using DCE perfusion data found that a plasma–volume ratio ≥ 2.6 identified progression versus radiation treatment effect with sensitivity of 91% and specificity of 80% (Hatzoglou et al, 2015). Although perfusion MRI-based rCBV appears more accurate than MRS (Huang et al, 2011), a meta-analysis has shown that both rCBV and Cho/Cr help differentiate true progression from radiation necrosis (Chuang et al, 2016). …”

Section: Caveats To Interpreting Posttreatment Imaging Changesmentioning

confidence: 99%

Brain metastases: neuroimaging

Pope

2018

Handbook of Clinical Neurology

148

130

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Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal patient management could be benefited by improved and well-validated prognostic and predictive imaging markers, as well as early response markers to identify successful treatment prior to changes in tumor size. To address these fundamental needs, newer MRI techniques including diffusion and perfusion imaging, MR spectroscopy, and positron emission tomography (PET) tracers beyond traditionally used 18-fluorodeoxyglucose are the subject of extensive ongoing investigations, with several promising avenues of added value already identified. These newer techniques provide a wealth of physiologic and metabolic information that may supplement standard MR evaluation, by providing the ability to monitor and characterize cellularity, angiogenesis, perfusion, pH, hypoxia, metabolite concentrations, and other critical features of malignancy. This chapter reviews standard and advanced imaging of brain metastases provided by computed tomography, MRI, and amino acid PET, focusing on potential biomarkers that can serve as problem-solving tools in the clinical management of patients with brain metastases.

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“…They report that an rCBV >2 had a sensitivity and specificity of 56 and 100 %, respectively. Interestingly, they also reported that the best reporter was the increase in lesional size, with a 65 % tumor volume increase, having a sensitivity and specificity of 100 and 65 % for tumor progression, respectively [31]. …”

Section: Imaging Modalities To Detect Pseudoprogressionmentioning

confidence: 99%

“…Likewise, in a study of 33 patients, Chernov et al reported that 1 H-MRS, using multi-voxel spectroscopy, could reliably define pure tumor recurrence, partial tumor recurrence, radiation-induced tumor necrosis, and radiation necrosis of the peritumoral brain using a combination of NAA/Cho and Lip/Cho ratios [10]. Huang et al reported that the Cho/contralateral brain Cho was the best performing value, with a sensitivity and specificity of 33 and 100 %, respectively [31]. …”

Section: Imaging Modalities To Detect Pseudoprogressionmentioning

confidence: 99%

Imaging changes following stereotactic radiosurgery for metastatic intracranial tumors: differentiating pseudoprogression from tumor progression and its effect on clinical practice

2013

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Stereotactic radiosurgery has become standard adjuvant treatment for patients with metastatic intracranial lesions. There has been a growing appreciation for benign imaging changes following radiation that are difficult to distinguish from true tumor progression. These imaging changes, termed pseudoprogression, carry significant implications for patient management. In this review, we discuss the current understanding of pseudoprogression in metastatic brain lesions, research to differentiate pseudoprogression from true progression, and clinical implications of pseudoprogression on treatment decisions.

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Differentiation between intra-axial metastatic tumor progression and radiation injury following fractionated radiation therapy or stereotactic radiosurgery using MR spectroscopy, perfusion MR imaging or volume progression modeling

Cited by 66 publications

References 20 publications

MRI perfusion in determining pseudoprogression in patients with glioblastoma

MRI perfusion in determining pseudoprogression in patients with glioblastoma

Brain metastases: neuroimaging

Imaging changes following stereotactic radiosurgery for metastatic intracranial tumors: differentiating pseudoprogression from tumor progression and its effect on clinical practice

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