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http://dx.doi.org/10.13104/jksmrm.2014.18.2.120

Differentiation of True Recurrence from Delayed Radiation Therapy-related Changes in Primary Brain Tumors Using Diffusion-weighted Imaging, Dynamic Susceptibility Contrast Perfusion Imaging, and Susceptibility-weighted Imaging  

Kim, Dong Hyeon (Department of Radiology, Seoul National University College of Medicine)
Choi, Seung Hong (Department of Radiology, Seoul National University College of Medicine)
Ryoo, Inseon (Department of Radiology, Seoul National University College of Medicine)
Yoon, Tae Jin (Department of Radiology, Seoul National University College of Medicine)
Kim, Tae Min (Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine)
Lee, Se-Hoon (Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine)
Park, Chul-Kee (Department of Neurosurgery, Seoul National University College of Medicine)
Kim, Ji-Hoon (Department of Radiology, Seoul National University College of Medicine)
Sohn, Chul-Ho (Department of Radiology, Seoul National University College of Medicine)
Park, Sung-Hye (Department of Pathology, Seoul National University College of Medicine)
Kim, Il Han (Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine)
Publication Information
Investigative Magnetic Resonance Imaging / v.18, no.2, 2014 , pp. 120-132 More about this Journal
Abstract
Purpose : To compare dynamic susceptibility contrast imaging, diffusion-weighted imaging, and susceptibility-weighted imaging (SWI) for the differentiation of tumor recurrence and delayed radiation therapy (RT)-related changes in patients treated with RT for primary brain tumors. Materials and Methods: We enrolled 24 patients treated with RT for various primary brain tumors, who showed newly appearing enhancing lesions more than one year after completion of RT on follow-up MRI. The enhancing-lesions were confirmed as recurrences (n=14) or RT-changes (n=10). We calculated the mean values of normalized cerebral blood volume (nCBV), apparent diffusion coefficient (ADC), and proportion of dark signal intensity on SWI (proSWI) for the enhancing-lesions. All the values between the two groups were compared using t-test. A multivariable logistic regression model was used to determine the best predictor of differential diagnosis. The cutoff value of the best predictor obtained from receiver-operating characteristic curve analysis was applied to calculate the sensitivity, specificity, and accuracy for the diagnosis. Results: The mean nCBV value was significantly higher in the recurrence group than in the RT-change group (P=.004), and the mean proSWI was significantly lower in the recurrence group (P<.001). However, no significant difference was observed in the mean ADC values between the two groups. A multivariable logistic regression analysis showed that proSWI was the only independent variable for the differentiation; the sensitivity, specificity, and accuracy were 78.6% (11 of 14), 100% (10 of 10), and 87.5% (21 of 24), respectively. Conclusion: The proSWI was the most promising parameter for the differentiation of newly developed enhancing-lesions more than one year after RT completion in brain tumor patients.
Keywords
Tumor recurrence; Radiation therapy-related change; Diffusion-weighted imaging; Perfusion imaging Susceptibility-weighted imaging;
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