Contrast-Enhanced Perfusion MR Imaging to Differentiate Between Recurrent/Residual Brain Neoplasms and Radiation Necrosis

Document Type: Research Articles

Authors

1 Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

2 Kasr El-Ainy Center of Clinical Oncology, Cairo University, Cairo, Egypt.

3 Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Purpose: To determine the value of dynamic susceptibility contrast enhanced (DSC) MRI (magnetic resonance imaging)
perfusion in the characterization of newly developed/enlarging lesions within irradiated regions after treatment of brain
tumors. Methods: This prospective cross-sectional study covered 23 patients, 12 females and 11 males. All cases
initially presented with histologically proven malignant brain tumors and underwent surgical intervention followed by
radiotherapy (+/- chemotherapy). On follow up imaging, they presented with newly developed/progressively enhancing
mass lesions at the sites of the primary tumors. All patients then underwent conventional MRI, DSC MRI perfusion
and MR spectroscopy. Results: In our study, we found DSC MR perfusion to be a useful non-invasive method for
differentiating recurrent brain tumors from radiation necrosis. This approach allows hemodynamic measurements to
be obtained within the brain as the relative cerebral blood volume (rCBV) to complement the anatomic information
obtained with conventional contrast enhanced MR imaging. The sensitivity and specificity of DSC MR perfusion
for differentiation were found to be 77.8% and 80.0%, respectively. Conclusion: DSC MR perfusion is a promising
technique in differentiating recurrent brain tumors from radiation necrosis as it has acceptable spatial resolution and
can be routinely performed in the same settings after conventional MRI.

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