• World Neurosurg · Feb 2021

    The Utilization of Treatment Response Assessment Maps in Discriminating Between Radiation Effect and Persistent Tumoral Lesion in Metastatic Brain Tumors Treated with Gamma Knife Radiosurgery.

    • Selcuk Peker, Yavuz Samanci, AygunMurat SerhatMSDepartment of Radiology, School of Medicine, Koç University, Istanbul, Turkey., Furkan Yavuz, ErdenMert EmreMESchool of Medicine, Koç University, Istanbul, Turkey., NokayAziz EmreAESchool of Medicine, Koç University, Istanbul, Turkey., AtasoyAli İhsanAİDepartment of Radiation Oncology, Koç University Hospital, Istanbul, Turkey., and Yasemin Bolukbasi.
    • Department of Neurosurgery, School of Medicine, Koç University, Istanbul, Turkey. Electronic address: peker@selcukpeker.com.
    • World Neurosurg. 2021 Feb 1; 146: e1134-e1146.

    BackgroundTraditional imaging modalities are not useful in the follow-up of irradiated metastatic brain tumors, because radiation can change imaging characteristics. We aimed to assess the ability of treatment response assessment maps (TRAMs) calculated from delayed-contrast magnetic resonance imaging (MRI) in differentiation between radiation effect and persistent tumoral tissue.MethodsTRAMs were calculated by subtracting three-dimensional T1 MRIs acquired 5 minutes after contrast injection from the images acquired 60-105 minutes later. Red areas were regarded as radiation effect and blue areas as persistent tumoral lesion. Thirty-seven patients with 130 metastatic brain tumors who were treated with Gamma Knife radiosurgery and who underwent TRAMs perfusion-weighted MRI were enrolled in this retrospective study.ResultsThe median age was 58 years and the most common primary diagnosis was lung cancer (n = 21). The median follow-up period of patients was 12 months. The overall local control rate was 100% at 1 year and 98.9% at 2 years. The median progression-free survival was 12 months. The mean overall survival was 27.3 months. The radiologic and clinical follow-up showed a clinicoradiologic diagnosis of a persistent tumoral lesion in 3 tumors (2.3%) and radiation effect in 127 tumors (97.7%). There was a fair agreement between clinicoradiologic diagnosis and TRAMs analysis (κ = 0.380). The sensitivity and positive predictive value of TRAMs in diagnosing radiation effect were 96.06% and 99.2%, respectively. TRAMs showed comparable results to perfusion-weighted MRI, with a diagnostic odds ratio of 27.4 versus 20.7, respectively.ConclusionsThe presented results show the ability of TRAMs in differentiating radiation effect and persistent tumoral lesions.Copyright © 2020 Elsevier Inc. All rights reserved.

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