Magnetic resonance spectroscopic study of radiogenic changes after radiosurgery of cerebral arteriovenous malformations with implications for the differential diagnosis of radionecrosis

Radiation Oncology

Frank Träber¹  Hans H Schild¹  Winfried Willinek¹  Wolfgang Block¹  Dariusch R Hadizadeh¹  Jan Boström² 

[1] Department of Radiology, University of Bonn Medical Center, Sigmund-Freud-Str. 25, Bonn 53105, Germany;Department of Radiosurgery and Stereotactic Radiotherapy, Mediclin Robert Janker Clinic, Villenstrasse 8, Bonn 53129, Germany

关键词: Radiosurgery;    Magnetic resonance angiography;    Magnetic resonance spectroscopy;    Radiation injury;    Radiation necrosis;   

Others  :  1154425
DOI  :  10.1186/1748-717X-8-54

 received in 2012-08-24, accepted in 2013-02-24,  发布年份 2013

【 摘 要 】

Background

The incidence of radionecrosis after radiosurgery is 5–20%. That radionecrosis after radiosurgery may be confused with a malignant tumor is a known phenomenon and problem.

Methods

Three similarly treated patients with cAVM, 1 patient with symptomatic radionecrosis and 2 patients with normal post-radiation MRI changes, were selected and studied in detail with magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and magnetic resonance spectroscopy (MRS). 2 cAVM were located in eloquent locations and were classified as Spetzler-Martin grade (SM) III such that interdisciplinary radiosurgery was recommended; a third patient with a left frontal SM II cAVM refused surgery. 1 patient was male, and 2 were female. The patient’s ages ranged from 38 to 62 years (median, 39 years). The nidus volume (= planning target volume = PTV) ranged from 2.75 to 6.89 ccm (median, 6.41 ccm). The single dose was 20 Gy at the isocenter of the PTV encompassing the 80 – 90% isodose. The median follow-up period was 20 months (range, 16 – 84 months). Toxicities were evaluated with the Common Terminology Criteria (CTC) for adverse events version 3.0.

Results

No patient suffered a bleeding from cAVM during the study period. A complete nidus occlusion was shown in all patients with time-resolved MRA. All patients showed radiogenic MRI changes, 1 patient showed excessive radionecrosis. This patient was oligosymptomatic and under temporary corticoid therapy symptoms resolved completely.

Following patterns associated with radionecrosis in the MRS studies were identified in our collective:

• 2D spectroscopic imaging (2D-SI) revealed much lower concentrations of metabolites in the lesion as compared to contralateral healthy tissue in all patients.

• Whereas regions with regular post-radiosurgery effects showed almost normal levels of Cho and a Cho/Cr ratio < 2.0, regions with radionecrosis were characterized by increased lipid levels and a Cho/Cr ratio > 2.0 in conjunction with decreased absolute levels of all metabolites, especially of Cr and NAA.

Conclusions

MRS is an increasingly valuable tool for the differential diagnosis of radiation reactions. Specific patterns of MRS spectra in radionecrosis were identified; in synopsis with clinical parameters, these changes have to be taken into account to avoid misdiagnosis.

【 授权许可】

   
2013 Boström et al.; licensee BioMed Central Ltd.

【 图 表 】

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