K Reddy MD, PhD; D Westerly PhD; C Chen MD.
Medical Imaging—Radiation Oncology—Original Article
MRI patterns of T1 enhancing radiation necrosis versus tumour recurrence in high-grade gliomas
Article first published online: 5 NOV 2012
© 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists
Journal of Medical Imaging and Radiation Oncology
Volume 57, Issue 3, pages 349–355, June 2013
How to Cite
Reddy, K., Westerly, D. and Chen, C. (2013), MRI patterns of T1 enhancing radiation necrosis versus tumour recurrence in high-grade gliomas. Journal of Medical Imaging and Radiation Oncology, 57: 349–355. doi: 10.1111/j.1754-9485.2012.02472.x
Conflict of interest: None.
- Issue published online: 31 MAY 2013
- Article first published online: 5 NOV 2012
- Manuscript Accepted: 30 JUL 2012
- Manuscript Received: 23 APR 2012
- contrast enhancement;
- radiation necrosis;
- tumour recurrence
Despite the emergence of new imaging technologies, the differentiation of treatment-related changes from recurrent tumour in patients with high-grade gliomas remains a difficult challenge. We evaluated whether specific MRI (magnetic resonance imaging) T1 post-contrast enhancement patterns can help to distinguish between radiation necrosis and tumour recurrence.
This study was approved by local institutional review board. Fifty-one patients with World Health Organization grade III–IV glioma underwent reoperation after prior chemoradiation. The percentage of radiation necrosis versus recurrent tumour in reoperation specimens was estimated by an experienced neuropathologist. Enhancement patterns on T1 post-contrast sequences from the MRIs obtained prior to reoperation were evaluated according to pathology.
T1 contrast enhancement patterns correlating with recurrent tumour included focal solid nodules and solid uniform enhancement with distinct margins. Eighty-five per cent (17/20) of patients with ≥70% recurrent tumour at reoperation demonstrated one of these patterns on preoperative MRI. Enhancement patterns correlating with radiation necrosis included a hazy mesh-like diffuse enhancement and rim enhancement with feathery indistinct margins. Ninety-four per cent (17/18) of patients with ≥70% radiation necrosis demonstrated one of these two patterns. Thirteen cases had more mixed pathology (>30% of tumour/necrosis) and demonstrated patterns associated with recurrence and/or necrosis. Compared to MR spectroscopy performed in 10 patients, enhancement patterns on MRI were just as accurate in predicting pathologic diagnosis.
Identifying distinct patterns of contrast enhancement on MRI may help to differentiate between radiation necrosis and tumour recurrence in high-grade gliomas.