Multivoxel proton MRS for differentiation of radiation-induced necrosis and tumor recurrence after gamma knife radiosurgery for brain metastases

被引:61
作者
Chernov, Mikhail F.
Hayashi, Motohiro
Izawa, Masahiro
Usukura, Masao
Yoshida, Shimetoshi
Ono, Yuko
Muragaki, Yoshihiro
Kubo, Osami
Hori, Tomokatsu
Takakura, Kintomo
机构
[1] Tokyo Womens Med Univ, Inst Neurol, Dept Neurosurg, Shinjuku Ku, Tokyo 1628666, Japan
[2] Tokyo Womens Med Univ, Inst Neurol, Dept Neuroradiol, Tokyo, Japan
关键词
radiosurgery; radiation necrosis; tumor recurrence; differential diagnosis; proton MRS;
D O I
10.1007/s10014-006-0194-9
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Multivoxel proton magnetic resonance spectroscopy (MRS) was used for differentiation of radiation-induced necrosis and tumor recurrence after gamma knife radiosurgery for intracranial metastases in 33 consecutive cases. All patients presented with enlargement of the treated lesion, increase of perilesional brain edema, and aggravation or appearance of neurological signs and symptoms on average 9.3 +/- 4.9 months after primary treatment. Metabolic imaging defined four types of lesions: pure tumor recurrence (11 cases), partial tumor recurrence (11 cases), radiation-induced tumor necrosis (10 cases), and radiation-induced necrosis of the peritumoral brain (1 case). In 1 patient, radiation-induced tumor necrosis was diagnosed 9 months after radiosurgery; however, partial tumor recurrence was identified 6 months later. With the exception of midline shift, which was found to be more typical for radiation-induced necrosis (P < 0.01), no one clinical, radiologic, or radiosurgical parameter either at the time of primary treatment or at the time of deterioration showed a statistically significant association with the type of the lesion. Proton MRS-based diagnosis was confirmed histologically in all surgically treated patients (7 cases) and corresponded well to the clinical course in others. In conclusion, multivoxel proton MRS is an effective diagnostic modality for identification of radiation-induced necrosis and tumor recurrence that can be used for monitoring of metabolic changes in intracranial neoplasms after radiosurgical treatment. It can be also helpful for differentiation of radiation-induced necrosis of the tumor and that of the peritumoral brain, which may have important clinical and medicolegal implications.
引用
收藏
页码:19 / 27
页数:9
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