Article Figures & Data
Figures
- Fig 1.
Individual images (A) CE MR imaging, thallium SPECT, FDG-PET, and ASL-MR imaging, and fused images (B) overlaid on CE-MR imaging. Red line represents the biopsy trajectory.
- Fig 2.
CE-MR imaging, thallium SPECT, FDG-PET, and ASL-MR images from case 1 (A) with metastatic renal cell carcinoma to periventricular white matter of the posterior left lateral horn. CE-MR imaging shows new enhancement in the region treated. SPECT was positive while PET and ASL were negative for tumor recurrence. Biopsy of the target region indicated radiation necrosis in case 2 (B) with metastatic breast cancer to the right cerebellum. CE-MR imaging shows new enhancement in the region treated. PET (SUV = 6.6) and ASL were positive for tumor recurrence. Biopsy of the target region indicated tumor recurrence in case 3 (C) with metastatic melanoma to the right inferior frontal cortex. Only PET was positive for tumor recurrence (SUV = 10.7). Biopsy of the target region indicated tumor recurrence.
Tables
- Table 1:
Demographic information, clinical course, location of tumor, radiation dose, time between SRS and follow-up imaging, biopsy results, and imaging results of each patienta
Pt Age (yr) Clinical Course Location SRS Dose SRS to Imaging Bx PET SPECT MR ASL 1 69 RCC, s/p SRS and stent, new CE Left paraventricular 22 Gy × 1 11 Mo RN Negative Positive Negative 2 63 NSCLC, s/p SRS, new CE Right frontal 19 Gy × 1 12 Mo TP SUV 20 Positive Positive 3 79 NSCLC, s/p SRS, neurologic deterioration Right frontal 22 Gy × 1 8 Mo RN SUV 4.9 Negative Negative 4 64 Esophageal cancer, s/p SRS, new CE Left frontal 21 Gy × 1 4 Mo TP Negative Positive Positive 5 72 SCLC, 3 lesions s/p WBRT + SRS Left parietal 22 Gy × 1 7 Mo TP SUV 10.3 Positive Positive 6 46 Breast cancer, s/p SRS, new CE Right cerebellar 22 Gy × 1 4 Mo TP SUV 6.6 Negative Positive 7 65 Melanoma, s/p SRS, neurologic decline Right temporal 18 Gy × 1 10 Mo RN SUV 7.2 Positive Negative 8 63 RCC, s/p SRS, new CE Right thalamus 16 Gy × 1 6 Mo RN Negative Negative Negative 9 58 Melanoma, s/p IR, enlarged CE Right frontal 19 Gy × 1 4 Mo TP SUV 10.7 Negative Negative 10 52 NSCLC, s/p SRS, new CE Right cerebellar 18 Gy × 1 3 Mo RN Negative Positive Negative 11 59 Melanoma, s/p SRS Left frontal 22 Gy × 1 3 Mo TP SUV 8 Negative Positive 12 52 Breast cancer, s/p SRS Right temporal 8 Gy × 3 11 Mo RN Negative Negative Negative 13 56 RCC, s/p SRS Left temporal 21 Gy × 1 12 Mo RN Negative Negative Negative 14 49 Melanoma, s/p SRS Right frontal 21 Gy × 1 8 Mo RN Negative Negative Negative Note:—RCC indicates renal cell carcinoma; Bx, biopsy; s/p, status-pos; IR, ionizing radiation; NSCLC, non-small cell lung cancer; SCLC, small cell lung cancer; WBRT, whole brain radiation therapy.
↵a Patients 1, 6, and 9 are those featured in the illustrative cases. Cells next to patients 1, 3, 7, 8, 10, and 12–14 represent RN on biopsy; other cells represent TN.
CE-MRI PET SPECT MR ASL Accuracy 46.2% 78.6% 57.1% 92.9% Sensitivity – 83.3% 50.0% 83.3% Specificity – 75.0% 62.5% 100.0% PPV – 71.4% 50.0% 100.0% NPV – 85.7% 62.5% 88.9% Note:— – indicates unable to calculate; CE-MRI were all positive for tumor progression.
PET or ASL + PET or SPECT + SPECT or ASL + Any One + Accuracy 85.7% 71.4% 71.4% 71.4% Sensitivity 100.0% 100.0% 66.7% 100.0% Specificity 75.0% 50.0% 62.5% 50.0% PPV 75.0% 60.0% 57.1% 60.0% NPV 100.0% 100.0% 71.4% 100.0% ↵a Positive = 1 modality positive.
PET and ASL + PET and SPECT + SPECT and ASL + All + Accuracy 85.7% 78.6% 78.6% 71.4% Sensitivity 66.7% 50.0% 66.7% 100.0% Specificity 100.0% 100.0% 100.0% 100.0% PPV 100.0% 100.0% 100.0% 100.0% NPV 80.0% 72.7% 72.7% 66.7% ↵a Positive = all modalities positive.
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