Cerebral Radiation Necrosis: An Analysis of Clinical and Quantitative Imaging and Volumetric Features.

Abstract:

BACKGROUND:Radiation therapy is an effective treatment for primary brain tumors and intracranial metastases but can occasionally precede new enhancing lesions on imaging studies that are difficult to discern between tumor recurrence (TR) and radiation necrosis (RN). The aim of this study was to identify clinical presentation and imaging patterns of RN compared with TR that may obviate the need for invasive definitive biopsy. METHODS:Patients who received radiation therapy and subsequently presented with a new intracranial lesion were reviewed from 2001 to 2016; 27 patients were identified with adequate records and confirmed pathology to have RN present or TR only. Patient and lesion characteristics were assessed using univariate and multivariate logistic regression analyses. Sensitivity and specificities were calculated for imaging features and quantitatively segmented lesion and edema volumes for identifying RN. RESULTS:Karnofsky performance scale score at presentation significantly predicted pathologic diagnosis on univariate analysis (P = 0.044). Radiation dosage and time from radiation therapy to lesion onset did not differ among pathologic diagnosis groups. No differences existed between RN and TR on quantitative imaging analyses. Multivariate logistic regression found higher Karnofsky performance scale score to be an independent factor associated with TR relative to RN (odds ratio 1.26, 95% confidence interval 1.02-1.56, P = 0.030). CONCLUSIONS:Diagnostic imaging can often be inaccurate in detecting RN alone, even with quantitative volume assessment. Functional status on repeat presentation may increase the likelihood of accurate diagnosis before definitive biopsy when neuroimaging remains unclear.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Feng R,Loewenstern J,Aggarwal A,Pawha P,Gilani A,Iloreta AM,Bakst R,Miles B,Bederson J,Costa A,Gupta V,Shrivastava RK

doi

10.1016/j.wneu.2017.12.104

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

e485-e494

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(17)32220-9

journal_volume

111

pub_type

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