Differentiation of True Recurrence from Delayed Radiation Therapy-related Changes in Primary Brain Tumors Using Diffusion-weighted Imaging, Dynamic Susceptibility Contrast Perfusion Imaging, and Susceptibility-weighted Imaging
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose : To compare dynamic susceptibility contrast imaging, diffusion-weighted imaging, and susceptibility-weightedimaging (SWI) for the differentiation of tumor recurrence and delayed radiation therapy (RT)-related changes in patientstreated with RT for primary brain tumors. Materials and Methods: We enrolled 24 patients treated with RT for various primary brain tumors, who showed newlyappearing enhancing lesions more than one year after completion of RT on follow-up MRI. The enhancing-lesions wereconfirmed as recurrences (n=14) or RT-changes (n=10). We calculated the mean values of normalized cerebral blood volume(nCBV), apparent diffusion coefficient (ADC), and proportion of dark signal intensity on SWI (proSWI) for theenhancing-lesions. All the values between the two groups were compared using t-test. A multivariable logistic regressionmodel was used to determine the best predictor of differential diagnosis. The cutoff value of the best predictor obtainedfrom receiver-operating characteristic curve analysis was applied to calculate the sensitivity, specificity, and accuracy forthe diagnosis. Results: The mean nCBV value was significantly higher in the recurrence group than in the RT-change group (P=.004),and the mean proSWI was significantly lower in the recurrence group (P<.001). However, no significant difference wasobserved in the mean ADC values between the two groups. A multivariable logistic regression analysis showed thatproSWI was the only independent variable for the differentiation; the sensitivity, specificity, and accuracy were 78.6% (11of 14), 100% (10 of 10), and 87.5% (21 of 24), respectively. Conclusion: The proSWI was the most promising parameter for the differentiation of newly developed enhancing-lesionsmore than one year after RT completion in brain tumor patients.
Abstract
Purpose : To compare dynamic susceptibility contrast imaging, diffusion-weighted imaging, and susceptibility-weightedimaging (SWI) for the differentiation of tumor recurrence and delayed radiation therapy (RT)-related changes in patientstreated with RT for primary brain tumors. Materials and Methods: We enrolled 24 patients treated with RT for various primary brain tumors, who showed newlyappearing enhancing lesions more than one year after completion of RT on follow-up MRI. The enhancing-lesions wereconfirmed as recurrences (n=14) or RT-changes (n=10). We calculated the mean values of normalized cerebral blood volume(nCBV), apparent diffusion coefficient (ADC), and proportion of dark signal intensity on SWI (proSWI) for theenhancing-lesions. All the values between the two groups were compared using t-test. A multivariable logistic regressionmodel was used to determine the best predictor of differential diagnosis. The cutoff value of the best predictor obtainedfrom receiver-operating characteristic curve analysis was applied to calculate the sensitivity, specificity, and accuracy forthe diagnosis. Results: The mean nCBV value was significantly higher in the recurrence group than in the RT-change group (P=.004),and the mean proSWI was significantly lower in the recurrence group (P<.001). However, no significant difference wasobserved in the mean ADC values between the two groups. A multivariable logistic regression analysis showed thatproSWI was the only independent variable for the differentiation; the sensitivity, specificity, and accuracy were 78.6% (11of 14), 100% (10 of 10), and 87.5% (21 of 24), respectively. Conclusion: The proSWI was the most promising parameter for the differentiation of newly developed enhancing-lesionsmore than one year after RT completion in brain tumor patients.
참고문헌 (45)
- Wang YX, "Evolution of radiationinduced brain injury: MR imaging-based study", Radiology, 254, pp.210~218 (2010)
- Mullins ME, "Radiation necrosis versus glioma recurrence:conventional MR imaging clues to diagnosis", AJNR Am J Neuroradiol, 26, pp.1967~1972 (2005)
- Kim HS, "Posttreatment high-grade glioma: usefulness of peak height position with semiquantitative MR perfusion histogram analysis in an entire contrast-enhanced lesion for predicting volume fraction of recurrence", Radiology, 256, pp.906~915 (2010)
- Chan YL, "Late radiation injury to the temporal lobes: morphologic evaluation at MR imaging", Radiology, 213, pp.800~807 (1999)
- Valk PE, "Radiation injury of the brain", AJNR Am J Neuroradiol, 12, pp.45~62 (1991)
- Dooms GC, "Brain radiation lesions: MR imaging", Radiology, 158, pp.149~155 (1986)
- Curran WJ, "Magnetic resonance imaging of cranial radiation lesions", Int J Radiat Oncol Biol Phys, 13, pp.1093~1098 (1987)
- Kim YH, "Differentiating radiation necrosis from tumor recurrence in highgrade gliomas: assessing the efficacy of 18F-FDG PET, 11C-methionine PET and perfusion MRI", Clin Neurol Neurosurg, 112, pp.758~765 (2010)
- Castillo M, "Apparent diffusion coefficients in the evaluation of high-grade gliomas", AJNR Am J Neuroradiol, 22, pp.60~64 (2001)
- Sugahara T, "Usefulness of diffusion weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas", J Magn Reson Imaging, 9, pp.53~60 (1999)
- Hein PA, "Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: tumor recurrence versus radiation injury", AJNR Am J Neuroradiol, 25, pp.201~209 (2004)
- Asao C, "Diffusion-weighted imaging of radiation-induced brain injury for differentiation from tumor recurrence", AJNR Am J Neuroradiol, 26, pp.1455~1460 (2005)
- Larsen VA, "Evaluation of dynamic contrast-enhanced T1-weighted perfusion MRI in the differentiation of tumor recurrence from radiation necrosis", Neuroradiology, 55, pp.361~369 (2013)
- Sugahara T, "Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrastenhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue", AJNR Am J Neuroradiol, 21, pp.901~909 (2000)
- Covarrubias DJ, "Dynamic magnetic resonance perfusion imaging of brain tumors", Oncologist, 9, pp.528~537 (2004)
- Thomas B, "Clinical applications of susceptibility weighted MR imaging of the brain -a pictorial review", Neuroradiology, 50, pp.105~116 (2008)
- Crossen JR, "Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy", J Clin Oncol, 12, pp.627~642 (1994)
- Giglio P, "Cerebral radiation necrosis", Neurologist, 9, pp.180~188 (2003)
- Heckl S, "Radiation-induced cavernous hemangiomas of the brain: a late effect predominantly in children", Cancer, 94, pp.3285~3291 (2002)
- Burn S, "Incidence of cavernoma development in children after radiotherapy for brain tumors", J Neurosurg, 106, pp.379~383 (2007)
- Sheline GE, "Radiation therapy of brain tumors", Cancer, 39, pp.873~881 (1977)
- Rosen BR, "Perfusion imaging with NMR contrast agents", Magn Reson Med, 14, pp.249~265 (1990)
- Ostergaard L, "High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: mathematical approach and statistical analysis", Magn Reson Med, 36, pp.715~725 (1996)
- Boxerman JL, "Relative cerebral blood volume maps corrected for contrast agent extravasation significantly correlate with glioma tumor grade, whereas uncorrected maps do not", AJNR Am J Neuroradiol, 27, pp.859~867 (2006)
- Wetzel SG, "Relative cerebral blood volume measurements in intracranial mass lesions: interobserver and intraobserver reproducibility study", Radiology, 224, pp.797~803 (2002)
- Hauck WW, "A proposal for examining and reporting stepwise regressions", Stat Med, 10, pp.711~715 (1991)
- Rosen BR, "Perfusion imaging with NMR contrast agents", Magn Reson Med, 14, pp.249~265 (1990)
- Hoefnagels FW, "Radiological progression of cerebral metastases after radiosurgery: assessment of perfusion MRI for differentiating between necrosis and recurrence", J Neurol, 256, pp.878~887 (2009)
- Barajas RF, "Distinguishing recurrent intra-axial metastatic tumor from radiation necrosis following gamma knife radiosurgery using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging", AJNR Am J Neuroradiol, 30, pp.367~372 (2009)
- Hu LS, "Relative cerebral blood volume values to differentiate high-grade glioma recurrence from posttreatment radiation effect: direct correlation between image-guided tissue histopathology and localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging measurements", AJNR Am J Neuroradiol, 30, pp.552~558 (2009)
- Gasparetto EL, "Posttreatment recurrence of malignant brain neoplasm: accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction", Radiology, 250, pp.887~896 (2009)
- Stadnik TW, "Diffusion-weighted MR imaging of intracerebral masses: comparison with conventional MR imaging and histologic findings", AJNR Am J Neuroradiol, 22, pp.969~976 (2001)
- Schaefer PW, "Assessing tissue viability with MR diffusion and perfusion imaging", AJNR Am J Neuroradiol, 24, pp.436~443 (2003)
- Guo AC, "Lymphomas and high-grade astrocytomas: comparison of water diffusibility and histologic characteristics", Radiology, 224, pp.177~183 (2002)
- Matsusue E, "Distinction between glioma progression and post-radiation change by combined physiologic MRimaging", Neuroradiology, 52, pp.297~306 (2010)
- Tung GA, "Diffusionweighted MR imaging of rim-enhancing brain masses: is markedly decreased water diffusion specific for brain abscess?", AJR Am J Roentgenol, 177, pp.709~712 (2001)
- Holtas S, "A ring-enhancing metastasis with central high signal on diffusion-weighted Imaging and low apparent diffusion coefficients", Neuroradiology, 42, pp.824~827 (2000)
- Biousse V, "Diffusion weighted imaging in radiation necrosis", J Neurol Neurosurg Psychiatry, 74, pp.382~384 (2003)
- Burger PC, "Radiation Injury to the Central Nervous System", pp.191~208 (1991), Raven
- Silvera S, "Spontaneous intracerebral hematoma on diffusion-weighted images: influence of T2-shine-through and T2-blackout effects", AJNR Am J Neuroradiol, 26, pp.236~241 (2005)
- Gaensler EH, "Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging", Radiology, 193, pp.629~636 (1994)
- Zeng QS, "Detection of hemorrhagic hypointense foci in radiation injury region using susceptibilityweighted imaging", Acta Radiol, 52, pp.115~119 (2011)
- Poussaint TY, "Hemorrhagic vasculopathy after treatment of central nervous system neoplasia in childhood: diagnosis and follow-up", AJNR Am J Neuroradiol, 16, pp.693~699 (1995)
- Llena JF, "Vascular alterations in delayed radiation necrosis of the brain. An electron microscopical study", Arch Pathol Lab Med, 100, pp.531~534 (1976)
- Okeda R, "Radiation encephalopathy: an autopsy case and some comments on the pathogenesis of delayed radionecrosis of the central nervous system", Acta Pathol Jpn, 23, pp.867~883 (1973)