Article Figures & Data
Figures
- Fig 1.
A, Axial noncontrast T1-weighted MR image obtained 18 months after resection and radiation of an anaplastic astrocytoma presenting with a hemorrhagic lesion in left parietal region. B, Postcontrast T1-weighted MR image demonstrates feathery Swiss cheese-like contrast enhancement surrounding the hemorrhagic lesion, suggestive of radiation injury. C, Axial T2-weighted MR image shows the extensive edema surrounding the lesion in the left hemisphere.
- Fig 2.
A, Postcontrast T1-weighted MR image obtained 12 months after resection and radiation of an ependymoma shows new contrast-enhancing lesions within the irradiated volume suspicious for tumor recurrence (arrow). B, 2D CSI MR spectroscopy (point-resolved spectroscopy sequence; TE, 144 ms, TR, 1500 ms) with manually placed voxels in the contrast-enhancing lesion and in the corresponding region in the contralateral hemisphere. C, 1H-MR spectrum shows moderately increased Cho and reduced NAA signal intensities (upper row), consistent with recurrent tumor, and normal signal intensities of NAA, Cho, and Cr in the right hemisphere (lower row).
- Fig 3.
A and B, Fluid-attenuated inversion recovery (FLAIR) (A) and postcontrast T1-weighted MR (B) images obtained 8 months after resection, radiation, and chemotherapy of an anaplastic oligodendroglioma in the left frontal lobe show a new area of hyperintensity on FLAIR (arrow, A) and a contrast-enhancing nodule (arrow, B) in the right frontal lobe within the irradiated volume, suspicious for radiation injury. C, Multivoxel 2D CSI MR spectroscopy (point-resolved spectroscopy sequence; TE, 144 ms; TR, 1500 ms) with manually placed voxels in the contrast-enhancing lesion and in the corresponding area in the left hemisphere. D, MR spectroscopy spectrum shows slightly decreased NAA and increased Cho signal intensities bilaterally, suggestive of radiation injury. A follow-up MR imaging (not shown) showed interval resolution of the enhancement and no new lesions.
- Fig 4.
A, Postcontrast T1-weighted image obtained 12 months after resection, radiation, and chemotherapy of an astrocytoma in the left frontal lobe shows diffuse feathery contrast-enhancing areas in the vicinity of the resection cavity within the irradiated volume, suspicious for tumor recurrence. B, Multivoxel 2D CSI MR spectroscopy (point-resolved spectroscopy sequence; TE, 144 ms; TR, 1500 ms) with manually placed voxels in contrast-enhancing areas, in the cystic cavity, and in normal-appearing brain parenchyma in both left and right hemispheres. C, Significantly increased Cho and almost-absent NAA signal intensities in the contrast-enhancing areas, consistent with tumor recurrence verified at histopathology.
- Fig 5.
A, Postcontrast T1-weighted image obtained 10 months after resection and radiation of an astrocytoma in the left frontal lobe shows an irregular peripherally contrast-enhancing mass lesion with central necrosis surrounded by edema suspicious for tumor recurrence. The patient had the lesion resected, and histopathology revealed a high-grade astrocytoma. B, At follow-up MR imaging 6 months later and after additional radiation, a new diffuse contrast-enhancing lesion was present within the irradiated volume. 1H-MR spectroscopy by using SVS (point-resolved spectroscopy sequence; TE, 144 ms; TR, 2000 ms) was performed with the volume placed in over the contrast-enhancing lesion. C, Slightly increased Cho and normal NAA and Cr signal intensities are indicative of radiation injury, which was histopathologically confirmed after additional resection.
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- Article
- Abstract
- Other Radiologic and Nuclear Medicine Methods to Discriminate Radiation Injury from Recurrent or Progressive Tumor
- Effects of Radiation on Normal Brain
- MR Spectroscopy in Radiation Injury
- Measurements of Metabolites and Ratio Calculations
- Need for Prediction Models for Clinical Decision Making
- Conclusions
- Acknowledgment
- References
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