EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force

Soffietti, Riccardo; Cornu, Philippe; Delattre, Jean‐Yves; Grant, Robin; Graus, Francesc; Grisold, Wolfgang; Heimans, J. J.; Hildebrand, Jerzy; Hoskin, Peter; Kalljo, M.; Krauseneck, P.; Marosi, Christine; Siegal, Tali; Vecht, Charles J.

doi:10.1111/j.1468-1331.2006.01506.x

Cited by 198 publications

(153 citation statements)

References 43 publications

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“…[33][34][35][36] PCI is part of the standard treatment protocol for SCLC patients. 17 However, over the past 25 years, the diagnostic tools used to stage and evaluate SCLC patients have evolved. In this study, we were able to show how this has led to changes in the application of PCI in our patient group (Table 4).…”

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confidence: 99%

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Detection of brain metastases from small cell lung cancer

Seute

Leffers

Velde

et al. 2008

Cancer

155

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BACKGROUNDThe aims of this study were to show 1) the effect of changing from computed tomography (CT) to magnetic resonance imaging (MRI) on the prevalence of detected brain metastases (BM) in patients with newly diagnosed small cell lung cancer (SCLC); 2) the difference in survival between patients with single and multiple BM; and 3) the effect of the change in patient labeling on eligibility for prophylactic brain irradiation.METHODSFrom 1980 to 2004, 481 consecutive patients with SCLC were enrolled. Brain imaging was routinely performed after diagnosis of SCLC. At the start of 1991, MRI replaced CT in almost all patients. All patients were regularly examined by a neurologist.RESULTSThe prevalence of detected BM was 10% in the CT era and 24% in the MRI era. In the CT era, all detected BM were symptomatic, whereas in the MRI era, 11% were asymptomatic. In both periods, patients labeled as single BM survived longer than those labeled as multiple BM. For patients labeled as single BM or multiple BM, survival was longer in the MRI era than in the CT era. The proportion of patients who were eligible for prophylactic cranial irradiation was lower in the MRI era.CONCLUSIONSThe estimated prevalence of BM increases when MRI is used instead of CT. Patients with a detected single BM survive longer than patients with multiple BM. The apparently increased survival in the MRI era can be attributed to the “Will Rogers phenomenon”. The use of MRI makes fewer patients eligible for prophylactic cranial irradiation. Cancer 2008. ©2008 American Cancer Society.

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confidence: 99%

“…15,16 However, recent guidelines and current opinions concerning the treatment of BM are based on studies in which BM were detected through CT. [17][18][19] It is debatable whether recommendations emanating from these studies are applicable to all patients with BM diagnosed through MRI.…”

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confidence: 99%

Detection of brain metastases from small cell lung cancer

Seute

Leffers

Velde

et al. 2008

Cancer

155

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“…18,20,25,28,29 Improving radiological imaging methods is instrumental for correctly ascertaining the size and number of lesions for resection and radiation treatment calculations. 20 In addition, the current prognostic characteristics of individual patients rely on recursive partitioning analysis, for which accurate imaging is essential.…”

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Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes

Kushnirsky

Nguyen

Katz

et al. 2016

JNS

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B rain metastases (BMs) are the most common intracranial tumors in adults, occurring in 20%-40% of cancer patients. 26 Their incidence has been increasing due to both prolonged systemic control and improved detection, making BMs a growing cause of mortality and morbidity.14,31 Magnetic resonance imaging is currently the standard of care for the diagnosis of BMs because its sensitivity is superior to CT,22,32 and refinements in MRI techniques allow the modality to detect metastases that are not seen with routine image-acquisition protocols. The abbreviatioNs BM = brain metastasis; GRE = gradient echo; SRS = stereotactic radiosurgery. obJective Contrast-enhanced MRI is the preeminent diagnostic test for brain metastasis (BM). Detection of BMs for stereotactic radiosurgery (SRS) planning may improve with a time delay following administration of a high-relaxivity agent for 1.5-T and 3-T imaging systems. Metastasis detection with time-delayed MRI was evaluated in this study. methods Fifty-three volumetric MRI studies from 38 patients undergoing SRS for BMs were evaluated. All studies used 0.1-mmol/kg gadobenate dimeglumine (MultiHance; Bracco Diagnostics) immediately after injection, followed by 2 more axial T1-weighted sequences after 5-minute intervals (final image acquisition commenced 15 minutes after contrast injection). Two studies were motion limited and excluded. Two hundred eighty-seven BMs were identified. The studies were randomized and examined separately by 3 radiologists, who were blinded to the temporal sequence. Each radiologist recorded the number of BMs detected per scan. A Wilcoxon signed-rank test compared BM numbers between scans. One radiologist determined the scan on which BMs were best defined. All confirmed, visible tumors were contoured using iPlan RT treatment planning software on each of the 3 MRI data sets. A linear mixed model was used to analyze volume changes. results The interclass correlations for Scans 1, 2, and 3 were 0.7392, 0.7951, and 0.7290, respectively, demonstrating excellent interrater reliability. At least 1 new lesion was detected in the second scan as compared with the first in 35.3% of subjects (95% CI 22.4%-49.9%). The increase in BM numbers between Scans 1 and 2 ranged from 1 to 10. At least 1 new lesion was detected in the third scan as compared with the second in 21.6% of subjects (95% CI 11.3%-35.3%). The increase in BM numbers between Scans 2 and 3 ranged from 1 to 9. Between Scans 1 and 3, additional tumors were seen on 43.1% of scans (increase ranged from 1 to 14). The median increase in tumor number for all comparisons was 1. There was a significant increase in number of BMs detected from Scan 1 to Scan 2 (p < 0.0367) and from Scan 1 to Scan 3 (p < 0.0264). In 34 of the 51 subjects (66.7%), the radiologist selected the third scan as the one providing the clearest tumor definition. There was an average 25.4% increase in BM volume between Scans 1 and 2 (p < 0.0001) and a 9% increase in BM volume between Scans 2 and 3 (p = 0.0001). coNclusioNs In patients who are ...

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“…Especially breast cancer, lung cancer, melanoma and renal cell cancer are known to develop brain metastases [1,2]. According to current guidelines, surgery is recommended for symptomatic and accessible brain metastases followed by whole-brain irradiation or stereotactic irradiation [3 -6].…”

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confidence: 99%

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

Bette

Gempt

Wiestler

et al. 2016

Fortschr Röntgenstr

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Results 3 of 6 cases with local tumor recurrence showed a FLAIR signal increase (sensitivity 50.0 %, specificity 100.0 %). In one case, this sign was observed even about 3 months before tumor recurrence.The specificity of FLAIR signal increase for overall tumor recurrence (local and distant) was also 100.0 %, but with a lower sensitivity of 13.0 %.Quantitative analysis showed significant differences for signal intensity of the resection cavity as well as for the change of signal intensity of the resection cavity in cases with or without local tumor recurrence.Conclusion An increase in FLAIR signal of the fluid within the resection cavity might be a highly specific and early sign of local tumor recurrence/tumor progression also for brain metastases. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.Key points: ▪ An increase in FLAIR signal intensity of the fluid within the resection cavity is also observed in previously resected brain metastases. ▪ The pathophysiology of this sign might be due to a cell-proliferative process.

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EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force

Cited by 198 publications

References 43 publications

Detection of brain metastases from small cell lung cancer

Detection of brain metastases from small cell lung cancer

Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

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