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Neuroradiology
Published in: Neuroradiology 3/2015

01-03-2015 | Functional Neuroradiology

23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note

Authors: Stefan Haneder, Frank A. Giordano, Simon Konstandin, Stefanie Brehmer, Karen A. Buesing, Peter Schmiedek, Lothar R. Schad, Frederik Wenz, Stefan O. Schoenberg, Melissa M. Ong

Published in: Neuroradiology | Issue 3/2015

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Abstract

Introduction

We report the first case of an intraoperative radiotherapy (IORT) in a patient with recurrent glioblastoma multiforme (GBM) who was followed up with a novel magnetic resonance imaging (MRI) method—23Na-MRI—in comparison to a standard contrast-enhanced 1H-MRI and 18F-FET-PET.

Methods

A 56-year-old female patient with diagnosed GBM in July 2012 underwent tumor resection, radiochemotherapy, and three cycles of chemotherapy. After a relapse, 6 months after the initial diagnosis, an IORT was recommended which was performed in March 2013 using the INTRABEAM system (Carl Zeiss Meditec AG, Germany) with a 3-cm applicator and a surface dose of 20 Gy. Early post-operative contrast-enhanced and 1-month follow-up 1H-MRI and a 18F-FET-PET were performed. In addition, an IRB-approved 23Na-MRI was performed on a 3.0-T MR scanner (MAGNETOM TimTrio, Siemens Healthcare, Germany).

Results

After re-surgery and IORT in March 2013, only a faint contrast enhancement but considerable surrounding edema was visible at the medio-posterior resection margins. In April 2013, new and progressive contrast enhancement, edema, 23Na content, and increased uptake in the 18F-FET-PET were visible, indicating tumor recurrence. Increased sodium content within the area of contrast enhancement was found in the 23Na-MRI, but also exceeding this area, very similar to the increased uptake depicted in the 18F-FET-PET. The clearly delineable zone of edema in both examinations exhibits a lower 23Na content compared to areas with suspected proliferating tumor tissue.

Conclusion

23Na-MRI provided similar information in the suspicious area compared to 18F-FET-PET, exceeding conventional 1H-MRI. Still, 23Na-MRI remains an investigational technique, which is worth to be further evaluated.
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Metadata
Title
23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note
Authors
Stefan Haneder
Frank A. Giordano
Simon Konstandin
Stefanie Brehmer
Karen A. Buesing
Peter Schmiedek
Lothar R. Schad
Frederik Wenz
Stefan O. Schoenberg
Melissa M. Ong
Publication date
01-03-2015
Publisher
Springer Berlin Heidelberg
Published in
Neuroradiology / Issue 3/2015
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-014-1468-2

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