Dynamic susceptibility contrast (DSC) perfusion MRI in differential diagnosis between radionecrosis and neoangiogenesis in cerebral metastases using rCBV, rCBF and K2

Muto, Mario; Frauenfelder, Giulia; Senese, Rossana; Zeccolini, Fabio; Schena, Emiliano; Giurazza, Francesco; Jäger, Hans Rolf

doi:10.1007/s11547-018-0866-7

Cited by 36 publications

(46 citation statements)

References 25 publications

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“…In the follow-up, recurrences often display similar imaging features to therapy-related changes, such as pseudoprogression or radionecrosis, and perfusion MRI is generally used to distinguish these conditions. For instance, dynamic susceptibility contrast perfusion has shown to be helpful for differentiating tumor recurrence, tumor necrosis, and pseudoprogression in patients treated for cerebral metastases, with relative cerebral blood volume of 2.1 having proven to be the most accurate perfusion parameter [ 6 ]. In this setting, the fifth percentile of the ADC histogram at a high b -value and mean ADC ≤ 1.3 × 10 −3 mm 2 /s allowed the differentiation between glioblastoma recurrence and treatment-related changes indicative of pseudoprogression [ 7 ].…”

Section: Neuromentioning

confidence: 99%

Diffusion-Weighted Imaging in Oncology: An Update

Messina

Bignone

Bruno

et al. 2020

Cancers

112

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To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the “functional” information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.

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Section: Neuromentioning

confidence: 99%

Diffusion-Weighted Imaging in Oncology: An Update

Messina

Bignone

Bruno

et al. 2020

Cancers

112

View full text Add to dashboard Cite

show abstract

“…Unfortunately, published data have been inconsistent. Hu et al reported rCBV of < 0.71 as 92% sensitivity and 100% specificity for radiation necrosis, while another suggested a rCBV cutoff of < 2.1 (100% sensitivity and specificity) ( 38 , 41 ). Barajas et al reported significant overlap in rCBV values and proposed using the percentage of signal-intensity recovery (PSR) ( 33 ).…”

Section: Diagnosis and Investigations For Patients With Suspected Rnmentioning

confidence: 99%

Diagnosis and Management of Radiation Necrosis in Patients With Brain Metastases

et al. 2018

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The use of radiotherapy, either in the form of stereotactic radiosurgery (SRS) or whole-brain radiotherapy (WBRT), remains the cornerstone for the treatment of brain metastases (BM). As the survival of patients with BM is being prolonged, due to improved systemic therapy (i.e., for better extra-cranial control) and increased use of SRS (i.e., for improved intra-cranial control), patients are clinically manifesting late effects of radiotherapy. One of these late effects is radiation necrosis (RN). Unfortunately, symptomatic RN is notoriously hard to diagnose and manage. The features of RN overlap considerably with tumor recurrence, and misdiagnosing RN as tumor recurrence may lead to deleterious treatment which may cause detrimental effects to the patient. In this review, we will explore the pathophysiology of RN, risk factors for its development, and the strategies to evaluate and manage RN.

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“…27 MRI spectroscopy using ratios of choline/creatine and/or choline/N-acetyl aspartate may contribute to a better distinction of radionecrosis, but is limited in small lesions and in the posterior fossa. 18,28 A combination of 18 F-FET PET and perfusion-weighted MRI was shown to improve the accuracy of glioma grading compared with MRI alone. 29 Specific literature data on the use of this combined technique for radiation necrosis vs vital brain metastases are currently lacking.…”

Section: Discussionmentioning

confidence: 99%

18F-FET PET for Diagnosis of Pseudoprogression of Brain Metastases in Patients With Non–Small Cell Lung Cancer

Akhoundova¹,

Hiltbrunner²,

Mader

et al. 2019

Clin Nucl Med

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PURPOSE To evaluate whether F-fluoroethyltyrosine (FET) PET can discriminate progression from pseudoprogression of brain metastases in patients with non-small cell lung cancer undergoing immunotherapy and radiotherapy to the brain. METHODS Retrospective analysis of F-FET PET scans in cases with documented progression of brain metastases on MRI in a cohort of 53 patients with nonsmall cell lung cancer receiving immune-checkpoint inhibitors and radiotherapy of brain metastases at the University Hospital of Zürich from June 2015 until January 2019. Response to radiotherapy was assessed by MRI. In case of equivocal findings and/or radiological progression in clinically asymptomatic patients, further assessment with F-FET PET was performed. RESULTS From the cohort of 53 patients, the restaging MRI showed in 30 patients (56.6%) progression of at least 1 treated metastasis. Thereof, F-FET PET was performed in 11 patients, based on the absence of neurological symptoms or presence of systemic response and physicians' decision. F-FET PET correctly identified pseudoprogression in 9 of 11 patients (81.8%). In patients who did not undergo F-FET PET, 5 of 19 (26.3%) were diagnosed with pseudoprogression. CONCLUSIONS Pseudoprogression of brain metastases occurred in 50% of patients diagnosed with progression on MRI. F-FET PET may help differentiate pseudoprogression from real progression in order to avoid discontinuation of effective therapy or unneeded interventions.

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Dynamic susceptibility contrast (DSC) perfusion MRI in differential diagnosis between radionecrosis and neoangiogenesis in cerebral metastases using rCBV, rCBF and K2

Abstract: DSC-MRI appears a clinically useful method to differentiate between tumor recurrence, tumor necrosis and pseudoprogression in patients treated for cerebral metastases. Relative CBV using a cut-off value of 2.1 proved to be the most accurate and reliable parameter.

Cited by 36 publications

References 25 publications

Diffusion-Weighted Imaging in Oncology: An Update

Diffusion-Weighted Imaging in Oncology: An Update

Diagnosis and Management of Radiation Necrosis in Patients With Brain Metastases

18F-FET PET for Diagnosis of Pseudoprogression of Brain Metastases in Patients With Non–Small Cell Lung Cancer

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