Highlights
- •MRI cannot reliably differentiate tumour recurrence from radiation change in brain metastases.
- •Multiparametric MRI including DWI, PWI and MRS may improve diagnostic accuracy.
- •Low ADC <1000, high rCBV ratio >2.1, high Cho:Cr ratio >1.8 imply tumour recurrence.
- •High ADC >1000, low rCBV ratio <2.1, Cho:Cr ratio <1.8 imply radiation changes.
Abstract
Aims
Following stereotactic radiosurgery (SRS), brain metastases initially increase in
size in up to a third of cases, suggesting treatment failure. Current imaging using
structural magnetic resonance imaging (MRI) cannot differentiate between tumour recurrence
and SRS-induced changes, creating difficulties with patient management. Combining
multiparametric MRI techniques, which assess tissue physiological and metabolic information,
has shown promise in answering this clinical question.
Materials and methods
Multiparametric MRI techniques, including spectroscopy, diffusion and perfusion imaging,
were used for the differentiation of radiation-related changes and tumour recurrence
after SRS for intracranial metastases in six cases. All patients presented with enlargement
of the treated lesion, an increase in perilesional brain oedema and aggravation or
appearance of neurological signs and symptoms from 7 to 29 weeks after primary treatment.
Results
Multiparametric imaging helped to differentiate features of tumour progression (n = 4) from radiation-related changes (n = 2). A low apparent diffusion coefficient (ADC) <1000 × 10−6 mm2/s, high relative cerebral blood volume (rCBV) ratio > 2.1, high choline:creatine
(Cho:Cr) ratio > 1.8 suggested tumour recurrence. A high ADC > 1000 × 10−6 mm2/s, low rCBV ratio < 2.1, Cho:Cr ratio < 1.8 suggested SRS-induced radiation changes.
Multiparametric MRI diagnosis was confirmed by histology or radiological and clinical
follow-up.
Conclusion
Multiparametric MRI was helpful in the early identification of radiation-related changes
and tumour recurrence and may be useful for monitoring treatment changes in intracranial
neoplasms after SRS treatment.
Key words
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Article Info
Publication History
Published online: September 28, 2018
Accepted:
August 16,
2018
Received in revised form:
August 3,
2018
Received:
April 27,
2018
Identification
Copyright
© 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
