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MRI patterns of T 1 enhancing radiation necrosis versus tumour recurrence in high‐grade gliomas
Author(s) -
Reddy Krishna,
Westerly David,
Chen Changhu
Publication year - 2013
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/j.1754-9485.2012.02472.x
Subject(s) - medicine , necrosis , magnetic resonance imaging , radiation therapy , glioma , nuclear medicine , radiology , pathology , cancer research
Despite the emergence of new imaging technologies, the differentiation of treatment‐related changes from recurrent tumour in patients with high‐grade gliomas remains a difficult challenge. We evaluated whether specific MRI (magnetic resonance imaging) T 1 post‐contrast enhancement patterns can help to distinguish between radiation necrosis and tumour recurrence. Methods This study was approved by local institutional review board. Fifty‐one patients with W orld H ealth O rganization grade III – IV glioma underwent reoperation after prior chemoradiation. The percentage of radiation necrosis versus recurrent tumour in reoperation specimens was estimated by an experienced neuropathologist. Enhancement patterns on T 1 post‐contrast sequences from the MRIs obtained prior to reoperation were evaluated according to pathology. Results T 1 contrast enhancement patterns correlating with recurrent tumour included focal solid nodules and solid uniform enhancement with distinct margins. Eighty‐five per cent (17/20) of patients with ≥70% recurrent tumour at reoperation demonstrated one of these patterns on preoperative MRI . Enhancement patterns correlating with radiation necrosis included a hazy mesh‐like diffuse enhancement and rim enhancement with feathery indistinct margins. Ninety‐four per cent (17/18) of patients with ≥70% radiation necrosis demonstrated one of these two patterns. Thirteen cases had more mixed pathology (>30% of tumour/necrosis) and demonstrated patterns associated with recurrence and/or necrosis. Compared to MR spectroscopy performed in 10 patients, enhancement patterns on MRI were just as accurate in predicting pathologic diagnosis. Conclusion Identifying distinct patterns of contrast enhancement on MRI may help to differentiate between radiation necrosis and tumour recurrence in high‐grade gliomas.