Radionecrosis of malignant glioma and cerebral metastasis: A diagnostic challenge in MRI

Raimbault, A.; Cazals, X.; Lauvin, M.-A.; Destrieux, Christophe; Chapet, S.; Cottier, Jean-Philippe

doi:10.1016/j.diii.2014.06.013

Cited by 44 publications

(35 citation statements)

References 68 publications

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“…In the literature, there are contradictory data. 20 In fact, the apparent diffusion coefficient values were found to be significantly lower in cases of tumor recurrence compared with radionecrosis in some studies; however, in other series, no significant difference was found between the groups. Moreover, in a study by Sundgren, the mean apparent diffusion coefficient values were found to be significantly higher in the recurrence group.…”

Section: Diagnosismentioning

confidence: 87%

Clinical management of grade III oligodendroglioma

Simonetti¹,

Gaviani²,

Botturi³

et al. 2015

CMAR

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Oligodendrogliomas represent the third most common type of glioma, comprising 4%–15% of all gliomas and can be classified by degree of malignancy into grade II and grade III, according to WHO classification. Only 30% of oligodendroglial tumors have anaplastic characteristics. Anaplastic oligodendroglioma (AO) is often localized as a single lesion in the white matter and in the cortex, rarely in brainstem or spinal cord. The management of AO is deeply changed in the recent years. Maximal safe surgical resection followed by radiotherapy (RT) was considered as the standard of care since paramount findings regarding molecular aspects, in particular co-deletion of the short arm of chromosome 1 and the long arm of chromosome 19, revealed that these subsets of AO, benefit in terms of overall survival (OS) and progression-free survival (PFS), from the addition of chemotherapy to RT. Allelic losses of chromosomes 1p and 19q occur in 50%–70% of both low-grade and anaplastic tumors, representing a strong prognostic factor and a powerful predictor of prolonged survival. Several other molecular markers have potential clinical significance as IDH1 mutations, confirming the strong prognostic role for OS. Malignant brain tumors negatively impacts on patients’ quality of life. Seizures, visual impairment, headache, and cognitive disorders can be present. Moreover, chemotherapy and RT have important side effects. For these reasons, “health-related quality of life” is becoming a topic of growing interest, investigating on physical, mental, emotional, and social well-being. Understanding the impact of medical treatment on health-related quality of life will probably have a growing effect both on health care strategies and on patients.

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Section: Diagnosismentioning

confidence: 87%

Clinical management of grade III oligodendroglioma

Simonetti¹,

Gaviani²,

Botturi³

et al. 2015

CMAR

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“…The response assessment in neuro-oncology (RANO) recommends using 2-dimensional measurements (diameter) of contrast enhancement on post-treatment Gadolinium-enhanced T1-weighted (Gd-T 1w ) MRI (with respect to pre-treatment MRI) as the fundamentally quantifiable imaging criteria for assessment of response to treatment. However, due to similar appearance on follow-up post-treatment Gd-T 1w MRI, differentiating RN and tumor recurrence using 2-dimensional measurements of contrast enhancement (as manually identified by an expert) is clinically extremely challenging [5]. Recent studies have displayed promise in utilizing semiquantitative MRI measures such as apparent diffusion coefficient ratios [6], choline, creatine, N-acetyl aspartate ratios from MR spectroscopy [7], and perfusion imaging [8] for differentiating RN from tumor recurrence.…”

Section: Introductionmentioning

confidence: 99%

Computer-Extracted Texture Features to Distinguish Cerebral Radionecrosis from Recurrent Brain Tumors on Multiparametric MRI: A Feasibility Study

Tiwari

Prasanna

Wolansky

et al. 2016

AJNR Am J Neuroradiol

100

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Purpose To determine the feasibility of radiomic (computer extracted texture) features in differentiating radiation necrosis (RN) from recurrent brain tumors on routine MRI (Gadolinium (Gd)-T1w, T2w, FLAIR). Methods A retrospective study of brain tumor MRI obtained after 9-months (or later) post-radio-chemotherapy was collected from two institutions. In total, 58 patient studies were analyzed, consisting of a training (N = 43) cohort from one institution and an independent test (N = 15) cohort from another, with surgical histologic findings confirmed by an experienced neuropathologist at the respective institutions. Brain lesions on MRI were manually annotated by an expert neuro-radiologist. A set of radiomic features was extracted for every lesion on each MRI sequence: Gd-T1w, T2w, FLAIR. Feature selection was employed to identify the top 5 most discriminating features for every MRI sequence on the training cohort. These features were then evaluated on the test cohort via a support vector machine (SVM) classifier. The classification performance was compared against diagnostic reads by two expert neuro-radiologists, who had access to the same MRI sequences (Gd-T1w, T2w, and FLAIR) as the classifier. Results On the training cohort, the area under the receiver operating characteristic curve (AUC) was highest for FLAIR with 0.79, 95% CI [0.77, 0.81] for primary (N =22), and 0.79, 95% CI [0.75, 0.83], for metastatic subgroups (N = 21). Of the 15 studies in the holdout cohort, the SVM classifier identified 12 of 15 studies correctly, while neuro-radiologist 1 diagnosed 7 of 15, and neuro-radiologist 2 diagnosed 8 of 15 studies correctly, respectively. Discussion Our preliminary results appear to suggest that radiomic features may provide complementary diagnostic information on routine MRI sequences that may improve distinction of RN from recurrence, both for primary and metastatic brain tumors.

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“…Cranial radiation can lead to radiation necrosis in from 3% to 25% of patients, often presenting with seizures. Radiation necrosis is more common between 6 and 18 months postradiation and is more likely to develop with higher, concentrated doses (radiosurgery) and re‐radiation …”

Section: Seizures In Patients Who Have Cancer With Brain Lesionsmentioning

confidence: 99%

“…Radiation necrosis is more common between 6 and 18 months postradiation and is more likely to develop with higher, concentrated doses (radiosurgery) and re-radiation. 21,22 Parenchymal brain metastases are encountered in 10% to 30% of patients with systemic cancer, 23 and, of these, 70% to 80% present with multiple metastases (especially melanoma and lung cancer). In men, the most common primary tumor is lung cancer (particularly non-small-cell lung cancer), whereas, in women, breast cancer (particularly triple negative 24 ) is the main offender.…”

Section: Seizures In Patients Who Have Cancer With Brain Lesionsmentioning

confidence: 99%

Seizures in patients with cancer

Castro

Milligan

2020

Cancer

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Seizures are common in patients with cancer and either result from brain lesions, paraneoplastic syndromes, and complications of cancer treatment or are provoked by systemic illness (metabolic derangements, infections). Evaluation should include a tailored history, neurologic examination, laboratory studies, neuroimaging, and electroencephalogram. In unprovoked seizures, antiepileptic drug (AED) treatment is required, and a nonenzyme‐inducing AED is preferred. Treatment of the underlying cancer with surgery, chemotherapy, and radiation therapy also can help reduce seizures. Benzodiazepines are useful in the treatment of both provoked seizures and breakthrough epileptic seizures and as first‐line treatment for status epilepticus. Counseling for safety is an important component in the care of a patient with cancer who has seizures. Good seizure management can be challenging but significantly improves the quality of life during all phases of care, including end‐of‐life care.

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Radionecrosis of malignant glioma and cerebral metastasis: A diagnostic challenge in MRI

Cited by 44 publications

References 68 publications

Clinical management of grade III oligodendroglioma

Clinical management of grade III oligodendroglioma

Computer-Extracted Texture Features to Distinguish Cerebral Radionecrosis from Recurrent Brain Tumors on Multiparametric MRI: A Feasibility Study

Seizures in patients with cancer

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