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European Radiology
Published in: European Radiology 3/2013

01-03-2013 | Neuro

Analysis of the layering pattern of the apparent diffusion coefficient (ADC) for differentiation of radiation necrosis from tumour progression

Authors: Jihoon Cha, Sung Tae Kim, Hyung-Jin Kim, Hye Jeong Kim, Byung-joon Kim, Pyoung Jeon, Keon Ha Kim, Hong Sik Byun

Published in: European Radiology | Issue 3/2013

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Abstract

Objectives

To evaluate the added value of diffusion-weighted imaging (DWI) to perfusion-weighted imaging (PWI) for differentiating tumour progression from radiation necrosis.

Methods

Sixteen consecutive patients who underwent removal of a metastatic brain tumour that increased in size after stereotactic radiosurgery were retrospectively reviewed. The layering of the ADC was categorised into three patterns. ADC values were measured on each layer, and the maximum rCBV was measured. rCBV and the layering pattern of the ADC of radiation necrosis and tumour progression were compared.

Results

Nine cases of radiation necrosis and seven cases of tumour progression were pathologically confirmed. Radiation necrosis (88.9 % vs. 14.3 %) showed a three-layer pattern of ADC with a middle layer of minimum ADC more frequently. If rCBV larger than 2.6 was used to differentiate radiation necrosis and tumour progression, the sensitivity was 100 % but specificity was 56 %. If the lesions with the three-layer pattern of ADC with moderately increased rCBV (2.6–4.1) were excluded from tumour progression, the sensitivity and specificity increased to 100 %.

Conclusions

The three-layer pattern of ADC shows high specificity in diagnosing radiation necrosis; therefore, combined analysis of the ADC pattern with rCBV may have added value in the correct differentiation of tumour progression from radiation necrosis.

Key Points

•MRI follow-up often reveals increasing size of enhancing lesions after stereotactic radiosurgery
•Inflammation around tumour necrosis increases regional cerebral blood volume (rCBV), mimicking progression
•A three-layer apparent diffusion coefficient (ADC) pattern on diffusion-weighted MRI suggests radiation necrosis.
•The combined use of rCBV and DW MRI enables accurate differentiation.
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Metadata
Title
Analysis of the layering pattern of the apparent diffusion coefficient (ADC) for differentiation of radiation necrosis from tumour progression
Authors
Jihoon Cha
Sung Tae Kim
Hyung-Jin Kim
Hye Jeong Kim
Byung-joon Kim
Pyoung Jeon
Keon Ha Kim
Hong Sik Byun
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2638-4

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