title: Quantitative computer-assisted analysis vs. visual estimation of MR imaging response of brain metastases to radiotherapy.
abstract: Using both quantitative computer-assisted analysis and visual estimation the MR imaging response of brain metastases to whole-brain radiotherapy (WBRT) was prospectively studied in 49 patients. Compared to the computer-assisted analysis, the precision of the visual estimation (by two readers in conference) of tumor response was determined. Also the radiological response was related to the clinical response. Six weeks after WBRT follow-up MR was performed in 27 of 49 patients. Of the remaining 22 patients without follow-up MR, 9 had died or deteriorated due to neurologic decline. In four patients (15%) tumor increase was demonstrated by computer-assisted analysis; in the other 23 patients tumor remained stable (15%) or decreased (70%). In 11 of the 27 patients, a second follow-up MR was obtained 26 wk after WBRT demonstrating tumor increase in seven patients (64%). Complete discordance between both assessment methods was noticed in only 4 of 38 MR scans (27 scans 6 wk after WBRT and 11 scans 26 wk after WBRT) with small quantitative changes in tumor volume. In 26 of 38 (68%) observations 6 and 26 wk after WBRT, there was a positive correlation between change in tumor volume and change in the Neurologic Status. Visual estimation analysis seems an appropriate method of routine therapy monitoring in individual patients with brain metastases. The computer-assisted analysis should be considered if precise response monitoring becomes critical.
authors.affiliation: Department of Neurology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Taphoorn
authors.forename: R A
authors.initials: RA
authors.lastname: Potman
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
authors.forename: J G
authors.initials: JG
authors.lastname: Weerts
authors.forename: J
authors.initials: J
authors.lastname: Valk
authors.forename: A B
authors.initials: AB
authors.lastname: Karim
authors.forename: J J
authors.initials: JJ
authors.lastname: Heimans
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology* / Q000528:radiation effects; D001929:Brain Edema / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary*; D002423:Cause of Death; D003907:Dexamethasone / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D015588:Observer Variation; D011446:Prospective Studies; D011871:Radiology; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D015996:Survival Rate
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone