Distinguishing Brain Metastasis Progression From Radiation Effects After Stereotactic Radiosurgery Using Longitudinal GRASP Dynamic Contrast-Enhanced MRI.
Neurosurgery
; 92(3): 497-506, 2023 03 01.
Article
en En
| MEDLINE
| ID: mdl-36700674
ABSTRACT
BACKGROUND:
Differentiating brain metastasis progression from radiation effects or radiation necrosis (RN) remains challenging. Golden-angle radial sparse parallel (GRASP) dynamic contrast-enhanced MRI provides high spatial and temporal resolution to analyze tissue enhancement, which may differ between tumor progression (TP) and RN.OBJECTIVE:
To investigate the utility of longitudinal GRASP MRI in distinguishing TP from RN after gamma knife stereotactic radiosurgery (SRS).METHODS:
We retrospectively evaluated 48 patients with brain metastasis managed with SRS at our institution from 2013 to 2020 who had GRASP MRI before and at least once after SRS. TP (n = 16) was pathologically confirmed. RN (n = 16) was diagnosed on either resected tissue without evidence of tumor or on lesion resolution on follow-up. As a reference, we included a separate group of patients with non-small-cell lung cancer that showed favorable response with tumor control and without RN on subsequent imaging (n = 16). Mean contrast washin and washout slopes normalized to the superior sagittal sinus were compared between groups. Receiver operating characteristic analysis was performed to determine diagnostic performance.RESULTS:
After SRS, progression showed a significantly steeper washin slope than RN on all 3 follow-up scans (scan 1 0.29 ± 0.16 vs 0.18 ± 0.08, P = .021; scan 2 0.35 ± 0.19 vs 0.18 ± 0.09, P = .004; scan 3 0.32 ± 0.12 vs 0.17 ± 0.07, P = .002). No significant differences were found in the post-SRS washout slope. Post-SRS washin slope differentiated progression and RN with an area under the curve (AUC) of 0.74, a sensitivity of 75%, and a specificity of 69% on scan 1; an AUC of 0.85, a sensitivity of 92%, and a specificity of 69% on scan 2; and an AUC of 0.87, a sensitivity of 63%, and a specificity of 100% on scan 3.CONCLUSION:
Longitudinal GRASP MRI may help to differentiate metastasis progression from RN.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Traumatismos por Radiación
/
Neoplasias Encefálicas
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Radiocirugia
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Carcinoma de Pulmón de Células no Pequeñas
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Neoplasias Pulmonares
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
Neurosurgery
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos