Keywords:
CNS, Contrast agents, Oncology, MR, Contrast agent-intravenous, Image registration, Image verification
Authors:
L. Admojo, J. Korte, N. Anderson, C. Phillips, L. Casperz, A. Lasocki; Melbourne, VIC/AU
DOI:
10.26044/ranzcr2021/R-0301
Results
RESULTS
TRAMs Analysis (Figure 1)
Three regions on TRAMs were identified, based on the correlation with the initial/early contrast-enhanced T1WI (C + T1WI) as displayed on figure 1.
Patient Demographics (Table 1)
- Median age = 52 (range 41-75); Female (n=7) vs Male (n=3).
- Histology: Breast cancer (n=6), non-small cell lung cancer (n=3), melanoma (n=1).
- Tumour location: parietal lobes (n=4), cerebellum (n=3), temporal lobe, occipital lobe and caudate nucleus (n=1 each).
Treatment Details (Table 2)
- SRS dose regimens were i) 18 or 20Gy in 1 fraction or ii) 24 or 27Gy in 3 fractions.
- One patient (case 1) had a small retreated volume within prior SRS field.
- One patient (case 3) had other SRS adjacent to prior fields with some dose overlap.
- Eight of the patients were concurrently receiving immunotherapy.
Patient’s Final Clinical Status (Figure 2)
- Six patients were diagnosed with RN, 3 patients had TR and 1 patient (case 2) had both RN and TR.
- Four patients had surgical resection and the histopathology results showed 2 RN and 2 TR.
- One patient (case 9) received further SRS based on a radiologic diagnosis of TR (confirmed on regression of lesion on MRI follow up).
- Five patients were diagnosed with RN through radiological findings alone (based on regression of the lesion on the subsequent MRIs).
- One patient deteriorated and died before the cut-off date (case 4).
Correlation of TRAMs Pattern and Patient’s Clinical Status (Figure 2)
- RN TRAMs pattern
- Homogenous central accumulation with peripheral clearance and surrounding accumulation (case 5,10).
- Mixed central and peripheral accumulation with surrounding accumulation (case 1, 4,6,7).
- TR TRAMs pattern
- Homogenous clearance of the central and peripheral region with accumulation of the surrounding region (case 8,9).
- 2 Exceptional TRAMs pattern
- Case 3 TRAMs pattern resembles RN pattern but clinically and histopathologically confirmed to be TR; The patient was also noted to have old RN site adjacent to the resected tumour.
- Case 2 TRAMs pattern resembles TR pattern but clinically confirmed to be RN; The patient also later developed tumour progression adjacent to the RN site (distinct from the RN lesion).
- TRAMs analysis potentially compromised due to the close proximity of tumour and radiation necrosis to each other.