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Parillo M, Mallio CA, Dekkers IA, Rovira À, van der Molen AJ, Quattrocchi CC. Late/delayed gadolinium enhancement in MRI after intravenous administration of extracellular gadolinium-based contrast agents: is it worth waiting? MAGMA (NEW YORK, N.Y.) 2024; 37:151-168. [PMID: 38386150 DOI: 10.1007/s10334-024-01151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
The acquisition of images minutes or even hours after intravenous extracellular gadolinium-based contrast agents (GBCA) administration ("Late/Delayed Gadolinium Enhancement" imaging; in this review, further termed LGE) has gained significant prominence in recent years in magnetic resonance imaging. The major limitation of LGE is the long examination time; thus, it becomes necessary to understand when it is worth waiting time after the intravenous injection of GBCA and which additional information comes from LGE. LGE can potentially be applied to various anatomical sites, such as heart, arterial vessels, lung, brain, abdomen, breast, and the musculoskeletal system, with different pathophysiological mechanisms. One of the most popular clinical applications of LGE regards the assessment of myocardial tissue thanks to its ability to highlight areas of acute myocardial damage and fibrotic tissues. Other frequently applied clinical contexts involve the study of the urinary tract with magnetic resonance urography and identifying pathological abdominal processes characterized by high fibrous stroma, such as biliary tract tumors, autoimmune pancreatitis, or intestinal fibrosis in Crohn's disease. One of the current areas of heightened research interest revolves around the possibility of non-invasively studying the dynamics of neurofluids in the brain (the glymphatic system), the disruption of which could underlie many neurological disorders.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Autonomous University of Barcelona and Hospital Vall d'Hebron, Passeig Vall d'Hebron, Barcelona, Spain
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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2
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Mayo ZS, Billena C, Suh JH, Lo SS, Chao ST. The dilemma of radiation necrosis from diagnosis to treatment in the management of brain metastases. Neuro Oncol 2024; 26:S56-S65. [PMID: 38437665 PMCID: PMC10911797 DOI: 10.1093/neuonc/noad188] [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] [Indexed: 03/06/2024] Open
Abstract
Radiation therapy with stereotactic radiosurgery (SRS) or whole brain radiation therapy is a mainstay of treatment for patients with brain metastases. The use of SRS in the management of brain metastases is becoming increasingly common and provides excellent local control. Cerebral radiation necrosis (RN) is a late complication of radiation treatment that can be seen months to years following treatment and is often indistinguishable from tumor progression on conventional imaging. In this review article, we explore risk factors associated with the development of radiation necrosis, advanced imaging modalities used to aid in diagnosis, and potential treatment strategies to manage side effects.
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Affiliation(s)
- Zachary S Mayo
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Cole Billena
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
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3
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Salans M, Ni L, Morin O, Ziemer B, Capaldi DPI, Raleigh DR, Vasudevan HN, Chew J, Nakamura J, Sneed PK, Boreta L, Villanueva-Meyer JE, Theodosopoulos P, Braunstein S. Adverse radiation effect versus tumor progression following stereotactic radiosurgery for brain metastases: Implications of radiologic uncertainty. J Neurooncol 2024; 166:535-546. [PMID: 38316705 PMCID: PMC10876820 DOI: 10.1007/s11060-024-04578-6] [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: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Adverse radiation effect (ARE) following stereotactic radiosurgery (SRS) for brain metastases is challenging to distinguish from tumor progression. This study characterizes the clinical implications of radiologic uncertainty (RU). METHODS Cases reviewed retrospectively at a single-institutional, multi-disciplinary SRS Tumor Board between 2015-2022 for RU following SRS were identified. Treatment history, diagnostic or therapeutic interventions performed upon RU resolution, and development of neurologic deficits surrounding intervention were obtained from the medical record. Differences in lesion volume and maximum diameter at RU onset versus resolution were compared with paired t-tests. Median time from RU onset to resolution was estimated using the Kaplan-Meier method. Univariate and multivariate associations between clinical characteristics and time to RU resolution were assessed with Cox proportional-hazards regression. RESULTS Among 128 lesions with RU, 23.5% had undergone ≥ 2 courses of radiation. Median maximum diameter (20 vs. 16 mm, p < 0.001) and volume (2.7 vs. 1.5 cc, p < 0.001) were larger upon RU resolution versus onset. RU resolution took > 6 and > 12 months in 25% and 7% of cases, respectively. Higher total EQD2 prior to RU onset (HR = 0.45, p = 0.03) and use of MR perfusion (HR = 0.56, p = 0.001) correlated with shorter time to resolution; larger volume (HR = 1.05, p = 0.006) portended longer time to resolution. Most lesions (57%) were diagnosed as ARE. Most patients (58%) underwent an intervention upon RU resolution; of these, 38% developed a neurologic deficit surrounding intervention. CONCLUSIONS RU resolution took > 6 months in > 25% of cases. RU may lead to suboptimal outcomes and symptom burden. Improved characterization of post-SRS RU is needed.
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Affiliation(s)
- Mia Salans
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Lisa Ni
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Olivier Morin
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Benjamin Ziemer
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Dante P I Capaldi
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
- Department of Neurosurgery, University of California San Francisco (DRR, JEVM, PT), San Francisco, USA
- Department of Pathology, University of California San Francisco (DRR), San Francisco, USA
| | - Harish N Vasudevan
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
- Department of Neurosurgery, University of California San Francisco (DRR, JEVM, PT), San Francisco, USA
| | - Jessica Chew
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Jean Nakamura
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Penny K Sneed
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Lauren Boreta
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA
| | - Javier E Villanueva-Meyer
- Department of Neurosurgery, University of California San Francisco (DRR, JEVM, PT), San Francisco, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco (JEVM), San Francisco, USA
| | - Philip Theodosopoulos
- Department of Neurosurgery, University of California San Francisco (DRR, JEVM, PT), San Francisco, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California San Francisco (MS, LN, OM, BZ, DPIC, DRR, HNV, JC, JN, PKS, LB, SB), 505 Parnassus Ave, L75, San Francisco, CA, 94158, USA.
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4
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Satvat N, Korczynski O, Müller-Eschner M, Othman AE, Schöffling V, Keric N, Ringel F, Sommer C, Brockmann MA, Reder S. A Rapid Late Enhancement MRI Protocol Improves Differentiation between Brain Tumor Recurrence and Treatment-Related Contrast Enhancement of Brain Parenchyma. Cancers (Basel) 2022; 14:cancers14225523. [PMID: 36428617 PMCID: PMC9688406 DOI: 10.3390/cancers14225523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Differentiation between tumor recurrence and treatment-related contrast enhancement in MRI can be difficult. Late enhancement MRI up to 75 min after contrast agent application has been shown to improve differentiation between tumor recurrence and treatment-related changes. We investigated the diagnostic performance of late enhancement using a rapid MRI protocol optimized for clinical workflow. METHODS Twenty-three patients with 28 lesions suspected for glioma recurrence underwent MRI including T1-MPRAGE-series acquired 2 and 20 min after contrast agent administration. Early contrast series were subtracted from late contrast series using motion correction. Contrast enhancing lesions were retrospectively and independently evaluated by two readers blinded to the patients' later clinical course and histology with or without the use of late enhancement series. Sensitivity, specificity, NPV, and PPV were calculated for both readers by comparing results of MRI with histological samples. RESULTS Using standard MR sequences, sensitivity, specificity, PPV, and NPV were 0.84, 0, 0.875, and 0 (reader 1) and 0.92, 0, 0.885, and 0 (reader 2), respectively. Early late enhancement increased sensitivity, specificity, PPV, and NPV to 1 for each value and for both readers. Inter-reader reliability increased from 0.632 (standard MRI sequences) to 1.0 (with early late enhancement). CONCLUSION The described rapid late enhancement MRI protocol improves MRI-based discrimination between tumor tissue and treatment-related changes of the brain parenchyma.
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Affiliation(s)
- Neda Satvat
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Oliver Korczynski
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Matthias Müller-Eschner
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Ahmed E. Othman
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Vanessa Schöffling
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Clemens Sommer
- Department of Neuropathology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
| | - Marc A. Brockmann
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
- Correspondence: ; Tel.: +49-6131-17-7139
| | - Sebastian Reder
- Department of Neuroradiology, University Medical Centre, Johannes Gutenberg-University of Mainz, 55131 Mainz, Germany
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Vellayappan BA, McGranahan T, Graber J, Taylor L, Venur V, Ellenbogen R, Sloan AE, Redmond KJ, Foote M, Chao ST, Suh JH, Chang EL, Sahgal A, Lo SS. Radiation Necrosis from Stereotactic Radiosurgery-How Do We Mitigate? Curr Treat Options Oncol 2021; 22:57. [PMID: 34097171 DOI: 10.1007/s11864-021-00854-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Intracranial stereotactic radiosurgery (SRS) is an effective and convenient treatment for many brain conditions. Data regarding safety come mostly from retrospective single institutional studies and a small number of prospective studies. Variations in target delineation, treatment delivery, imaging follow-up protocols and dose prescription limit the interpretation of this data. There has been much clinical focus on radiation necrosis (RN) in particular, as it is being increasingly recognized on follow-up imaging. Symptomatic RN may be treated with medical therapy (such as corticosteroids and bevacizumab) with surgical resection being reserved for refractory patients. Nevertheless, RN remains a challenging condition to manage, and therefore upfront patient selection for SRS remains critical to provide complication-free control. Mitigation strategies need to be considered in situations where the baseline risk of RN is expected to be high-such as large target volume or re-irradiation. These may involve reduction in the prescribed dose or hypofractionated stereotactic radiation therapy (HSRT). Recently published guidelines and international meta-analysis report the benefit of HSRT in larger lesions, without compromising control rates. However, careful attention to planning parameters and SRS techniques still need to be adhered, even with HSRT. In cases where the risk is deemed to be high despite mitigation, a combination approach of surgery with or without post-operative radiation should be considered.
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Affiliation(s)
- Balamurugan A Vellayappan
- Department of Radiation oncology, National University Cancer Institute, 1E Kent Ridge Road, Level 7 Tower block, Singapore, 119228, Singapore.
| | - Tresa McGranahan
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Jerome Graber
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Lynne Taylor
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Vyshak Venur
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Richard Ellenbogen
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, Seidman Cancer Center and University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Samuel T Chao
- Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John H Suh
- Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
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Kaufmann TJ, Smits M, Boxerman J, Huang R, Barboriak DP, Weller M, Chung C, Tsien C, Brown PD, Shankar L, Galanis E, Gerstner E, van den Bent MJ, Burns TC, Parney IF, Dunn G, Brastianos PK, Lin NU, Wen PY, Ellingson BM. Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases. Neuro Oncol 2021; 22:757-772. [PMID: 32048719 PMCID: PMC7283031 DOI: 10.1093/neuonc/noaa030] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A recent meeting was held on March 22, 2019, among the FDA, clinical scientists, pharmaceutical and biotech companies, clinical trials cooperative groups, and patient advocacy groups to discuss challenges and potential solutions for increasing development of therapeutics for central nervous system metastases. A key issue identified at this meeting was the need for consistent tumor measurement for reliable tumor response assessment, including the first step of standardized image acquisition with an MRI protocol that could be implemented in multicenter studies aimed at testing new therapeutics. This document builds upon previous consensus recommendations for a standardized brain tumor imaging protocol (BTIP) in high-grade gliomas and defines a protocol for brain metastases (BTIP-BM) that addresses unique challenges associated with assessment of CNS metastases. The "minimum standard" recommended pulse sequences include: (i) parameter matched pre- and post-contrast inversion recovery (IR)-prepared, isotropic 3D T1-weighted gradient echo (IR-GRE); (ii) axial 2D T2-weighted turbo spin echo acquired after injection of gadolinium-based contrast agent and before post-contrast 3D T1-weighted images; (iii) axial 2D or 3D T2-weighted fluid attenuated inversion recovery; (iv) axial 2D, 3-directional diffusion-weighted images; and (v) post-contrast 2D T1-weighted spin echo images for increased lesion conspicuity. Recommended sequence parameters are provided for both 1.5T and 3T MR systems. An "ideal" protocol is also provided, which replaces IR-GRE with 3D TSE T1-weighted imaging pre- and post-gadolinium, and is best performed at 3T, for which dynamic susceptibility contrast perfusion is included. Recommended perfusion parameters are given.
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Affiliation(s)
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Raymond Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel P Barboriak
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina Tsien
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Evanthia Galanis
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Gerstner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Terry C Burns
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin Dunn
- Department of Neurological Surgery, Washington University, St Louis, Missouri, USA
| | - Priscilla K Brastianos
- Departments of Medicine and Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Departments of Radiological Sciences and Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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7
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Li H, Deng L, Bai HX, Sun J, Cao Y, Tao Y, States LJ, Farwell MD, Zhang P, Xiao B, Yang L. Diagnostic Accuracy of Amino Acid and FDG-PET in Differentiating Brain Metastasis Recurrence from Radionecrosis after Radiotherapy: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:280-288. [PMID: 29242363 DOI: 10.3174/ajnr.a5472] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current studies that analyze the usefulness of amino acid and FDG-PET in distinguishing brain metastasis recurrence and radionecrosis after radiation therapy are limited by small cohort size. PURPOSE Our aim was to assess the diagnostic accuracy of amino acid and FDG-PET in differentiating brain metastasis recurrence from radionecrosis after radiation therapy. DATA SOURCES Studies were retrieved from PubMed, Embase, and the Cochrane Library. STUDY SELECTION Fifteen studies were included from the literature. Each study used PET to differentiate radiation necrosis from tumor recurrence in contrast-enhancing lesions on follow-up brain MR imaging after treating brain metastasis with radiation therapy. DATA ANALYSIS Data were analyzed with a bivariate random-effects model. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were pooled, and a summary receiver operating characteristic curve was fit to the data. DATA SYNTHESIS The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of PET were 0.85, 0.88, 7.0, 0.17, and 40, respectively. The area under the receiver operating characteristic curve was 0.93. On subgroup analysis of different tracers, amino acid and FDG-PET had similar diagnostic accuracy. Meta-regression analysis demonstrated that the method of quantification based on patient, lesion, or PET scan (based on lesion versus not, P = .07) contributed to the heterogeneity. LIMITATIONS Our study was limited by small sample size, and 60% of the included studies were of retrospective design. CONCLUSIONS Amino acid and FDG-PET had good diagnostic accuracy in differentiating brain metastasis recurrence from radionecrosis after radiation therapy.
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Affiliation(s)
- H Li
- From the Department of Neurology (H.L., L.D., L.Y.), Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China
| | - L Deng
- From the Department of Neurology (H.L., L.D., L.Y.), Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China
| | - H X Bai
- Departments of Radiology (H.X.B., J.S., M.D.F.)
| | - J Sun
- Departments of Radiology (H.X.B., J.S., M.D.F.)
| | - Y Cao
- Cancer Research Institute (Y.C., Y.T.), Central South University, Changsha, Hunan Province, People's Republic of China
| | - Y Tao
- Cancer Research Institute (Y.C., Y.T.), Central South University, Changsha, Hunan Province, People's Republic of China
| | - L J States
- Department of Radiology (L.J.S.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - M D Farwell
- Departments of Radiology (H.X.B., J.S., M.D.F.)
| | - P Zhang
- Pathology (P.Z.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - B Xiao
- Department of Neurology (B.X.), Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China.
| | - L Yang
- From the Department of Neurology (H.L., L.D., L.Y.), Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China
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