Black holes, white dwarfs and supernovas: imaging after radiosurgery.
OBJECTIVE
To evaluate the imaging and pathological correlates of successful or risk-related stereotactic radiosurgery (SR). Methods and Materials. The ten-year Gamma Knife experience in 2,344 patients at the University of Pittsburgh was reviewed. In addition, the results or radiosurgery primate, rat, and mouse models were analyzed. Successful results and untoward complications were evaluated.


RESULTS
Dose, volume, location and histology affected the imaging changes seen after SR. Imaging changes range from central loss of contrast ('black holes'), shrinkage with diffuse contrast uptake ('white dwarfs'), or stabilization or growth arrest. Limited pathological data indicates that the prevention of cell division coupled with vascular obliteration results in tumor control, whereas a progressive endothelial proliferative and obliterative response results in arteriovenous malformation (AVM) obliteration. Perilesional imaging changes, especially in vascular malformations, may reflect flow phenomena, interstitial edema, or profound reactive astrocytosis ('supernovas').


CONCLUSIONS
Imaging changes correlate with both success and risks of stereotactic radiosurgery; however, pathological correlates are limited. High resolution neurodiagnostic imaging provides the best quality control available to assess the response to stereotactic radiosurgery. In the future, additional molecular probes are necessary to assess the radiobiological effects of radiosurgery.
Department of Neurological Surgery, University of Pittsburgh Medical Center,Pittsburgh, Pa., USA. lunsford@neuronet.pitt.edu
L D
LD
Lunsford
D
D
Kondziolka
A
A
Maitz
J C
JC
Flickinger
D000818:Animals; D001253:Astrocytes / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001927:Brain Diseases / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D003287:Contrast Media; D006801:Humans; D008279:Magnetic Resonance Imaging; D051379:Mice; D010215:Papio; D011183:Postoperative Complications / Q000473:pathology; D011184:Postoperative Period; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation*; D051381:Rats; D013238:Stereotaxic Techniques / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome
D003287:Contrast Media