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Shibahara D, Tanaka K, Togao O, Shiraishi Y, Yoneshima Y, Iwama E, Yoshitake T, Ishigami K, Okamoto I. Bevacizumab for Brain Radiation Necrosis in Patients With Nonsquamous Nonsmall Cell Lung Cancer. Clin Lung Cancer 2024:S1525-7304(24)00135-9. [PMID: 39068108 DOI: 10.1016/j.cllc.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Daisuke Shibahara
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
| | - Kentaro Tanaka
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yoshimasa Shiraishi
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yasuto Yoneshima
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Eiji Iwama
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Tadamasa Yoshitake
- Department of Radiology Informatics and Network, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Isamu Okamoto
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
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Aggarwal A, Aggarwal AK, Prakash S, Vile DJ, Aggarwal A. Narrow interval dual phase 18F-FDG PET/CT: A practical approach for distinguishing tumor recurrence from radiation necrosis in brain metastasis. Medicine (Baltimore) 2024; 103:e37789. [PMID: 38701250 PMCID: PMC11062716 DOI: 10.1097/md.0000000000037789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/14/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose of our research is to demonstrate efficacy of narrow interval dual phase [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging in distinguishing tumor recurrence (TR) from radiation necrosis (RN) in patients treated for brain metastases. 35 consecutive patients (22 female, 13 male) with various cancer subtypes, lesion size > 1.0 cm3, and suspected recurrence on brain magnetic resonance imaging (MRI) underwent narrow interval dual phase FDG-PET/CT (30 and 90 min after tracer injection). Clinical outcome was determined via sequential MRIs or pathology reports. Maximum standard uptake value (SUVmax) of lesion (L), gray matter (GM), and white matter (WM) was measured on early (1) and delayed (2) imaging. Analyzed variables include % change, late phase, and early phase for L uptake, L/GM uptake, and L/WM uptake. Statistical analysis (P < .01), receiver operator characteristic (ROC) curve and area under curve (AUC) cutoff values were obtained. Change in L/GM ratio of > -2% was 95% sensitive, 91% specific, and 93% accurate (P < .001, AUC = 0.99) in distinguishing TR from RN. Change in SUVmax of lesion alone was the second-best indicator (P < .001, AUC = 0.94) with an ROC cutoff > 30.5% yielding 86% sensitivity, 83% specificity, and 84% accuracy. Other variables (L alone or L/GM ratios in early or late phase, all L/WM ratios) were significantly less accurate. Utilizing narrow interval dual phase FDG-PET/CT in patients with brain metastasis treated with radiation therapy provides a practical approach to distinguish TR from RN. Narrow time interval allows for better patient comfort, greater efficiency of PET/CT scanner, and lower disruption of workflow.
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Affiliation(s)
- Aashri Aggarwal
- Department of Computer Science, Cornell University, Ithaca, NY
- Research Intern at Johnston Willis Hospital, Department of Radiology, Richmond, VA
| | - Ashwin K. Aggarwal
- Research Intern at Johnston Willis Hospital, Department of Radiology, Richmond, VA
- High school senior at Collegiate School, Richmond, VA
| | - Siddhant Prakash
- Research Intern at Johnston Willis Hospital, Department of Radiology, Richmond, VA
- Undergraduate student at Wake Forest University, NC
| | - Douglas J. Vile
- Department of Gamma Knife and Neuroscience Center, Johnston Willis Hospital, Richmond, VA
- Hospital Corporation of America, Richmond, VA
| | - Atul Aggarwal
- Johnston Willis Hospital, Department of Radiology, Richmond, VA
- Radiology Associates of Richmond, Richmond, VA
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Zamanian M, Abedi I, Danazadeh F, Amouheidari A, Shahreza BO. Post-chemo-radiotherapy response and pseudo-progression evaluation on glioma cell types by multi-parametric magnetic resonance imaging: a prospective study. BMC Med Imaging 2023; 23:176. [PMID: 37932656 PMCID: PMC10626695 DOI: 10.1186/s12880-023-01135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND We focused on Differentiated pseudoprogression (PPN) of progression (PN) and the response to radiotherapy (RT) or chemoradiotherapy (CRT) using diffusion and metabolic imaging. METHODS Seventy-five patients with glioma were included in this prospective study (approved by the Iranian Registry of Clinical Trials (IRCT) (IRCT20230904059352N1) in September 2023). Contrast-enhanced lesion volume (CELV), non-enhanced lesion volume (NELV), necrotic tumor volume (NTV), and quantitative values of apparent diffusion coefficient (ADC) and magnetic resonance spectroscopy (Cho/Cr, Cho/NAA and NAA/Cr) were calculated by a neuroradiologist using a semi-automatic method. All patients were followed at one and six months after CRT. RESULTS The results of the study showed statistically significant changes before and six months after RT-CRT for M-CELV in all glioma types (𝑝 < 0.05). In glioma cell types, the changes in M-ADC, M-Cho/Cr, and Cho/NAA indices for PN were incremental and greater for PPN patients. M-NAA/Cr ratio decreased after six months which was significant only on PN for GBM, and Epn (𝑝 < 0.05). A significant difference was observed between diffusion indices, metabolic ratios, and CELV changes after six months in all types (𝑝 < 0.05). None of the patients were suspected PPN one month after treatment. The DWI/ADC indices had higher sensitivity and specificity (98.25% and 96.57%, respectively). CONCLUSION The results of the present study showed that ADC values and Cho/Cr and Cho/NAA ratios can be used to differentiate between patients with PPN and PN, although ADC is more sensitive and specific.
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Affiliation(s)
- Maryam Zamanian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iraj Abedi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fatemeh Danazadeh
- Department of Radiology, School of Paramedicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Mayo ZS, Halima A, Broughman JR, Smile TD, Tom MC, Murphy ES, Suh JH, Lo SS, Barnett GH, Wu G, Johnson S, Chao ST. Radiation necrosis or tumor progression? A review of the radiographic modalities used in the diagnosis of cerebral radiation necrosis. J Neurooncol 2023; 161:23-31. [PMID: 36633800 DOI: 10.1007/s11060-022-04225-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Cerebral radiation necrosis is a complication of radiation therapy that can be seen months to years following radiation treatment. Differentiating radiation necrosis from tumor progression on standard magnetic resonance imaging (MRI) is often difficult and advanced imaging techniques may be needed to make an accurate diagnosis. The purpose of this article is to review the imaging modalities used in differentiating radiation necrosis from tumor progression following radiation therapy for brain metastases. METHODS We performed a review of the literature addressing the radiographic modalities used in the diagnosis of radiation necrosis. RESULTS Differentiating radiation necrosis from tumor progression remains a diagnostic challenge and advanced imaging modalities are often required to make a definitive diagnosis. If diagnostic uncertainty remains following conventional imaging, a multi-modality diagnostic approach with perfusion MRI, magnetic resonance spectroscopy (MRS), positron emission tomography (PET), single photon emission spectroscopy (SPECT), and radiomics may be used to improve diagnosis. CONCLUSION Several imaging modalities exist to aid in the diagnosis of radiation necrosis. Future studies developing advanced imaging techniques are needed.
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Affiliation(s)
- Zachary S Mayo
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA
| | - Ahmed Halima
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA
| | - James R Broughman
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA
| | - Timothy D Smile
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA
| | - Martin C Tom
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Gene H Barnett
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Guiyun Wu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Scott Johnson
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave CA-50, Cleveland, OH, 44195, USA. .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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Teunissen WHT, Govaerts CW, Kramer MCA, Labrecque JA, Smits M, Dirven L, van der Hoorn A. Diagnostic accuracy of MRI techniques for treatment response evaluation in patients with brain metastasis: A systematic review and meta-analysis. Radiother Oncol 2022; 177:121-133. [PMID: 36377093 DOI: 10.1016/j.radonc.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Treatment response assessment in patients with brain metastasis uses contrast enhanced T1-weighted MRI. Advanced MRI techniques have been studied, but the diagnostic accuracy is not well known. Therefore, we performed a metaanalysis to assess the diagnostic accuracy of the currently available MRI techniques for treatment response. METHODS A systematic literature search was done. Study selection and data extraction were done by two authors independently. Meta-analysis was performed using a bivariate random effects model. An independent cohort was used for DSC perfusion external validation of diagnostic accuracy. RESULTS Anatomical MRI (16 studies, 726 lesions) showed a pooled sensitivity of 79% and a specificity of 76%. DCE perfusion (4 studies, 114 lesions) showed a pooled sensitivity of 74% and a specificity of 92%. DSC perfusion (12 studies, 418 lesions) showed a pooled sensitivity was 83% with a specificity of 78%. Diffusion weighted imaging (7 studies, 288 lesions) showed a pooled sensitivity of 67% and a specificity of 79%. MRS (4 studies, 54 lesions) showed a pooled sensitivity of 80% and a specificity of 78%. Combined techniques (6 studies, 375 lesions) showed a pooled sensitivity of 84% and a specificity of 88%. External validation of DSC showed a lower sensitivity and a higher specificity for the reported cut-off values included in this metaanalysis. CONCLUSION A combination of techniques shows the highest diagnostic accuracy differentiating tumor progression from treatment induced abnormalities. External validation of imaging results is important to better define the reliability of imaging results with the different techniques.
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Affiliation(s)
- Wouter H T Teunissen
- Erasmus MC, department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands; Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Medical Delta, Delft, The Netherlands
| | - Chris W Govaerts
- University Medical Center Groningen, Medical imaging center, department of Radiology, Groningen, the Netherlands
| | - Miranda C A Kramer
- University Medical Center Groningen, department of Radiotherapy, Groningen, the Netherlands
| | - Jeremy A Labrecque
- Erasmus MC, Netherlands Institute for Health Science (NIHES), Rotterdam, the Netherlands
| | - Marion Smits
- Erasmus MC, department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands; Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Medical Delta, Delft, The Netherlands
| | - Linda Dirven
- Leiden University Medical Center, department of Neurology, Leiden, the Netherlands; Haaglanden Medical Center, department of Neurology, The Hague, the Netherlands
| | - Anouk van der Hoorn
- University Medical Center Groningen, Medical imaging center, department of Radiology, Groningen, the Netherlands.
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