Distinguishing Recurrent Primary Brain Tumor from Radiation Injury: A Preliminary Study Using a Susceptibility-Weighted MR Imaging−Guided Apparent Diffusion Coefficient Analysis Strategy

Abstract

BACKGROUND AND PURPOSE:The accurate delineation of tumor recurrence presents a significant problem in neuro-oncology. Our aim was to improve the identification of brain tumor recurrence from chemoradiation injury by using CE-SWI, a technique that provides improved visualization of the heterogeneous patterns of brain tumor pathology, to guide the analysis of ADC measures within the peritumoral territory.

Histogram Analysis of Intravoxel Incoherent Motion for Differentiating Recurrent Tumor from Treatment Effect in Patients with Glioblastoma: Initial Clinical Experience

“…Several previous studies have shown that the ADC value with a monoexponential model can help to differentiate tumor recurrence from treatment-related change. 14,15 Our study showed that D10 differed more significantly between the recurrent tumor and the treatment effect groups than did ADC10. Although the exact pathophysiologic mechanism for determining the difference between the ADC10 and D10 results is unclear, the significant perfusion difference between the recurrent tumor and the treatment effect groups may contribute to the ADC-D difference.…”

Utility of Intravoxel Incoherent Motion MR Imaging for Distinguishing Recurrent Metastatic Tumor from Treatment Effect following Gamma Knife Radiosurgery: Initial Experience

“…Several previous studies have shown that the ADC value derived from a monoexponential model can help differentiate tumor recurrence from treatmentrelated change. 14,15 Most interesting, our study showed that D10 differed more significantly between the recurrent tumor and the treatment effect groups than did ADC10. Although the exact pathophysiologic mechanism for determining the difference between the ADC10 and D10 results is unclear, the significant perfusion difference between the recurrent tumor and the treatment effect groups may contribute to the ADC-D difference.…”

Pseudoprogression: Relevance With Respect to Treatment of High-Grade Gliomas

“…Of these eleven patients with recurrent GBM, five underwent biopsy and pathology review. Notably of the five patients with biopsy, the sample is described as confirming tumor re-growth, but there was no further description of the pathology and no correlation with specific imaging features [32].…”

“…While early reporting that supported the notion of pseudoprogression included pathologic validation (seven samples out of 15 undergoing operation for re-resection [8]), published reports including pathology correlations with imaging are surprisingly few. One study claiming to specifically correlate imaging with pathology in patients treated with TMZbased chemoradiation [32] included seventeen patients and eleven were followed that showed tumor recurrence. Of these eleven patients with recurrent GBM, five underwent biopsy and pathology review.…”