Differentiation of posttreatment effects from glioma recurrence using arterial spin labeling, susceptibility-weighted imaging, proton MR spectroscopy and diffusion-weighted imaging as non-contrast brain MRI at 3 Tesla.

Congress:

ECR 2013

Poster Number:

C-1825

Type:

Scientific Exhibit

Keywords:

Neuroradiology brain, Oncology, MR, MR-Diffusion/Perfusion, MR-Spectroscopy, Imaging sequences, Neoplasia

Authors:

S. Lavrnic¹, M. Jovanovic¹, S. Gavrilovic¹, B. Vasić¹, D. Dzelebdzic¹, T. Stosic-Opincal²; ¹BELGRADE/RS, ²Beograd/RS

DOI:

10.1594/ecr2013/C-1825

DOI-Link:

https://dx.doi.org/10.1594/ecr2013/C-1825

Fig. 2: Recurrent glioblastoma multiforme in 32-year-old man. (A) Axial...

Fig. 4: Posttreatment effects of glioblastoma multiforme in 55-year-old man. (A) Axial...

Fig. 1: Recurrent glioblastoma multiforme in 32-year-old man. Axial T2-weighted image...

Fig. 3: Posttreatment effects of glioblastoma multiforme in 55-year-old man. Axial...

Purpose

The purpose of this study was to determine the contribution of arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), proton MR spectroscopy (1H-MRS) and diffusion-weighted imaging (DWI) metrics in the differentiation of posttreatment effects from recurrent glioma, and to assess the clinical value of non-contrast brain MRI protocol at 3T.

Methods and Materials

Follow-up brain MRI examinations were performed in 27 patients (19 men, 8 women; mean age 54.2 years) after surgery and/or radio and chemotherapy of gliomas. From all of them, 21 patients had histological conformed glioblastoma multiforme (WHO grade IV), 5 had anaplastic astrocytomas (WHO grade III), and 1 was with diffuse astrocytoma (WHO grade II). All MR images were performed with a 3T system (Skyra, Siemens, Germany). Imaging protocols included the following MR sequences: axial TSE T2 weighted imaging, axial SE T1 weighted imaging, coronal...

Results

The neuroradiologists accurately differentiated tumor from posttreatment effects in 22 (81.5%) in the first review, 23 (85.2%) in the second review and 25 (91%) in the third review. Sensitivity, specificity, positive and negative predictive values of the non-contrast protocol for differentiation of recurrent tumor vs. posttreatment effects were 81.3%, 81.8%, 86.7% and 75.0%, respectively.

Conclusion

The non-contrast protocol provided diagnostic information comparable to contrast protocol which makes it suitable for patients who have a contraindication or cannot tolerate a bolus injection of paramagnetic contrast medium.

References

- Brandsma D, Stalpers L, Taal W, et al. Clinical features, mechanisms and management of pseudoprogression in malignant gliomas. Lancet Oncol 2008; 9: 453–61. - Essig M, Anzalone N, Combs SE, et al. MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice. AJNR Am J Neuroradiol 2012; 33: 803–17. - Barajas R, Chang J, Segal M, et al. Differentiation of Recurrent Glioblastoma Multiforme from Radiation Necrosis after External Beam Radiation Therapy with Dynamic Susceptibility weighted Contrast-enhanced Perfusion MR Imaging. Radiology...