Differentiation of recurrent spinal ependymoma from postradiation treatment necrosis through multiparametric PET-MR and perfusion MRI

Hojjati, Mojgan; Garg, Vasant; Badve, Chaitra; Abboud, Salim; Sloan, Andrew E.; Wolansky, Leo

doi:10.1016/j.clinimag.2016.09.002

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…8,9 However, each technique has its strengths and limitations, and validation in clinical trials is mandatory for the successful implementation of these techniques. [9][10][11] We conducted the present study to evaluate the usefulness of MET PET/CT and PWI for the differentiation of recurrence from radiation injury in patients with HGGs and quantitatively analyze the diagnostic values of MET PET/CT and PWI parameters. We also aimed to assess the combined diagnostic performance of the 2 modalities with regard to the therapeutic response of tumors.…”

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confidence: 99%

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and ¹¹C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

Zhen¹,

Zhao²,

Wang³

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Both 11 C-methionine PET/CT and DSC-PWI could be used to differentiate radiation injury from recurrent brain tumors. Our aim was to assess the performance of MET PET/CT and DSC-PWI for differentiation of recurrence and radiation injury in patients with high-grade gliomas and to quantitatively analyze the diagnostic values of PET and PWI parameters. MATERIALS AND METHODS: Forty-two patients with high-grade gliomas were enrolled in this study. The final diagnosis was determined by histopathologic analysis or clinical follow-up. PWI and PET parameters were recorded and compared between patients with recurrence and those with radiation injury using Student t tests. Receiver operating characteristic and logistic regression analyses were used to determine the diagnostic performance of each parameter. RESULTS: The final diagnosis was recurrence in 33 patients and radiation injury in 9. PET/CT showed a patient-based sensitivity and specificity of 0.909 and 0.556, respectively, while PWI showed values of 0.667 and 0.778, respectively. The maximum standardized uptake value, mean standardized uptake value, tumor-to-background maximum standardized uptake value, and mean relative CBV were significantly higher for patients with recurrence than for patients with radiation injury. All these parameters showed a high discriminative power in receiver operating characteristic analysis. The optimal cutoff values for the tumor-to-background maximum standardized uptake value and mean relative CBV were 1.85 and 1.83, respectively, and corresponding sensitivities and specificities for the diagnosis of recurrence were 0.97 and 0.667 and 0.788 and 0.88, respectively. Areas under the curve for the tumor-to-background maximum standardized uptake value and mean relative CBV were 0.847 Ϯ 0.077 and 0.845 Ϯ 0.078, respectively. Combined assessment of the tumor-to-background maximum standardized uptake value and mean relative CBV showed the largest area under the curve (0.953 Ϯ 0.031), with corresponding sensitivity and specificity of 0.848 and 1.0, respectively. CONCLUSIONS: Both 11 C-methionine PET/CT and PWI are equally accurate in the differentiation of recurrence from radiation injury in patients with high-grade gliomas, and a combination of the 2 modalities could result in increased diagnostic accuracy. ABBREVIATIONS: AUC ϭ area under the curve; MET ϭ 11 C-methionine; HGG ϭ high-grade glioma; max ϭ maximum; rCBV ϭ relative CBV; SUV ϭ standardized uptake value; TBR ϭ tumor-to-background G liomas are the most common primary brain tumors. Tumor resection followed by postoperative chemotherapy and radiation therapy is the primary treatment for gliomas. However, radiation therapy may damage normal brain tissue and result in adverse effects involving the brain. Classically, radiation injury can be classified into acute and delayed reactions. Radiation-induced necrosis is the most severe form of radiation injury and usually occurs 3-12 months after radiation therapy, though it can also occur years after treatment. The incid...

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confidence: 99%

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and ¹¹C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

Zhen¹,

Zhao²,

Wang³

et al. 2019

AJNR Am J Neuroradiol

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“…The use of positron emission tomography (PET) 36 , 13C labeled metabolites such as 13C-pyruvate 37 , and cation exchange saturation transfer (CEST) imaging 38 may be able to allow investigators and clinicians to image altered glucose uptake, energy production, and glutamate neurotransmitter fluctuations, respectively, in acute and late toxicities.…”

Section: Imaging Cns Radiation Effectsmentioning

confidence: 99%

Radiation Toxicity in the Central Nervous System: Mechanisms and Strategies for Injury Reduction

Smart

2017

Seminars in Radiation Oncology

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The potential for radiation-induced toxicities in the brain produce significant anxiety, both among patients receiving radiation therapy and those radiation oncologists providing treatment. These concerns often play a significant role in the medical decision making process for most patients with diseases in which radiotherapy may be a treatment consideration1. While the precise mechanisms of neurotoxicity and neurodegeneration following ionizing radiation exposure continue to be poorly understood from a biological perspective, there is an increasing body of scientific and clinical literature that is producing a better understanding of how radiation causes brain injury, factors which determine whether toxicities occur, and potential preventative, treatment and mitigation strategies for patients at high risk or with symptoms of injury. This review will focus primarily on injuries and biological processes described in mature brain.

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Differentiation of recurrent spinal ependymoma from postradiation treatment necrosis through multiparametric PET-MR and perfusion MRI

Cited by 2 publications

References 17 publications

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and ¹¹C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and ¹¹C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

Radiation Toxicity in the Central Nervous System: Mechanisms and Strategies for Injury Reduction

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Differentiation of recurrent spinal ependymoma from postradiation treatment necrosis through multiparametric PET-MR and perfusion MRI

Cited by 2 publications

References 17 publications

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and 11C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and 11C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

Radiation Toxicity in the Central Nervous System: Mechanisms and Strategies for Injury Reduction

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Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and ¹¹C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and ¹¹C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas