Rationale and Objectives
To compare differences in diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance (MR) perfusion imaging characteristics of recurrent neoplasm and radiation necrosis in patients with brain tumors previously treated with radiotherapy with or without surgery and chemotherapy.
Materials and Methods
Patients with a history of brain neoplasm previously treated with radiotherapy with or without chemotherapy and surgery who developed a new enhancing lesion on posttreatment surveillance MRI were enrolled. DSC perfusion MRI and DTI were performed. Region of interest cursors were manually drawn in the contrast-enhancing lesions, in the perilesional white matter edema, and in the contralateral normal-appearing frontal lobe white matter. DTI and DSC perfusion MR indices were compared in recurrent tumor versus radiation necrosis.
Results
Twenty-two patients with 24 lesions were included. Sixteen (67%) lesions were placed into the recurrent neoplasm group and eight (33%) lesions were placed into the radiation necrosis group using biopsy results as the gold standard in all but three patients. Mean apparent diffusion coefficient values, mean parallel eigenvalues, and mean perpendicular eigenvalues in the contrast-enhancing lesion were significantly lower, and relative cerebral blood volume was significantly higher for the recurrent neoplasm group compared to the radiation necrosis group ( P < 0.01, P = 0.03, P < 0.01, and P < 0.01, respectively).
Conclusions
The combined assessment of DTI and DSC MR perfusion properties of new contrast-enhancing lesions is helpful in distinguishing recurrent neoplasm from radiation necrosis in patients with a history of brain neoplasm previously treated with radiotherapy with or without surgery and chemotherapy.
Introduction
Conventional magnetic resonance imaging (MRI) is not reliable in distinguishing radiation necrosis from recurrent brain neoplasm in patients with brain tumors previously treated with radiation therapy and surgery . Stereotactic biopsy and resection remain the most reliable methods for the classification of enhancing lesions that develop in the posttreatment period . In recent years, dynamic susceptibility-weighted contrast-enhanced (DSC) MR perfusion imaging and diffusion tensor imaging (DTI) have been used to evaluate posttreatment brain tumor patients. Multiple studies have shown significantly higher relative cerebral blood volume (rCBV) in the contrast-enhancing lesions of patients with recurrent tumor compared to those of patients with radiation necrosis . Whereas some studies have shown enhancing lesion apparent diffusion coefficient (ADC) values or ratios to be lower in recurrent neoplasms as opposed to radiation necrosis , other studies have shown contradictory findings . Few studies have published findings specifically examining the DTI characteristics (fractional anisotropy [FA], eigenvalues) of these lesions .
Our study prospectively analyzes both DSC MR perfusion and DTI characteristics of new enhancing lesions in patients with brain tumors previously treated with radiation therapy with or without surgery and chemotherapy.
Materials and Methods
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Subjects
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Table 1
Patient Demographics
Patient No. Sex Age Primary Tumor Diagnosis Time to Lesion Detection 1 Male 18 Diffuse astrocytoma Tumor 42 2 Female 57 Metastatic breast cancer Tumor 51 3 Male 41 Mixed glioma Tumor 61 4 Male 42 GBM Necrosis 14 5 Male 20 GBM Tumor 10 6 Male \* 28 Anaplastic glioma Necrosis/Tumor 14, 28 7 Male 48 Anaplastic astrocytoma Necrosis 11 8 Male 43 Metastatic lung cancer Necrosis 41 9 Male 63 GBM Tumor 12 10 Male 51 GBM Tumor 18 11 Male 54 GBM Necrosis 4 12 Male 69 Metastatic lung cancer Tumor 8 13 Female 62 GBM Tumor 17 14 Male \* 62 Anaplastic oligodendroglioma Necrosis/Tumor 173, 210 15 Male 68 Anaplastic oligodendroglioma Tumor 395 16 Male 56 GBM Tumor 23 17 Female 56 GBM Necrosis 15 18 Female 51 Anaplastic astrocytoma Tumor 68 19 Female 60 Mixed glioma Tumor 8 20 Female 66 Oligodendroglioma Tumor 146 21 Female 34 Anaplastic oligodendroglioma Tumor 37 22 Female 78 GBM Necrosis 50
GBM, glioblastoma multiforme; Necrosis, radiation necrosis; Tumor, recurrent tumor.
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MRI Technique
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Data Acquisition and Postprocessing
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Histologic Analysis
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Data Analysis
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Results
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Table 2
Results
ADC FA λ1 λ⊥ rCBV Group 1 (contrast-enhancing lesion) 1.01 ± 0.19 0.23 ± 0.10 1.25 × ±0.24 0.89 × ±0.19 3.76 ± 1.95 Group 2 (contrast-enhancing lesion) 1.26 ± 0.08 0.16 ± 0.06 1.46 × ±0.11 1.15 × ±0.09 0.99 ± 0.25P value (contrast-enhancing lesion) <0.01 0.07 0.03 <0.01 <0.01 Group 1 (perilesional edema) 1.24 ± 0.44 0.27 ± 0.15 1.55 ± 0.42 1.08 ± 0.47 1.48 ± 1.29 Group 2 (perilesional edema) 1.28 ± 0.29 0.21 ± 0.10 1.56 ± 0.33 1.15 ± 0.29 0.62 ± 0.52P value (perilesional edema) 0.79 0.32 0.95 0.72 0.17 Group 1 (contralateral white matter) 0.80 ± 0.08 0.56 ± 0.08 1.35 ± 0.19 0.52 ± 0.08 n/a Group 2 contralateral white matter) 0.75 ± 0.05 0.50 ± 0.12 1.21 ± 0.16 0.53 ± 0.9 n/a_P_ value (contralateral white matter) 0.18 0.23 0.09 0.93 n/a
ADC, apparent diffusion coefficient; FA, fractional anisotropy; rCBV, relative cerebral blood volume.
ADC values and eigenvalues are in units of 10 −3 mm 2 /s. FA and rCBV values are unit-less.
Group 1, recurrent neoplasm; Group 2, radiation necrosis.
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Discussion
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Acknowledgments
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