title: Serial CT and MR imaging of carmustine wafers.
abstract: OBJECTIVE
  A new option in the treatment of recurrent malignant glioma is surgical placement of chemotherapy-laden biodegradable wafers. We describe the CT and MR appearance of chemotherapy wafers in patients after surgery for recurrent malignant glioma
  
  
  METHODS
  Eighteen patients had carmustine (BCNU) wafers implanted during reoperation for malignant glioma; three patients had empty, placebo wafers placed. The 21 patients had a total of 22 CT and 57 MR imaging studies. Repeat CT studies were conducted for up to 6 months, the MR studies for up to 1 year. Examinations were evaluated for attenuation on CT scans, signal abnormalities on MR images, and changing appearance during the follow-up period. Enhancement characteristics were also assessed.
  
  
  RESULTS
  On CT scans, 13 of 16 acute (<7 days) cases showed linear high-attenuation wafers, with three showing low attenuation. On MR images, all T1 and T2 studies performed in the acute stage showed decreased signal of the wafers. Eight of 15 studies showed a transient increase in T1 only at about 2 months. Wafers decreased in conspicuity on both CT and MR studies after 2 months. The wafers did not enhance. One postoperative tumor showed a transient increase in edema and increased enhancement at 5 weeks. The presence or absence of BCNU within the wafers did not change their appearance.
  
  
  CONCLUSIONS
  BCNU wafers have a characteristic appearance: in the first 7 days after implantation they are linear, usually of increased attenuation on CT scans, and always show decreased signal on MR images; they do not enhance, and become less conspicuous after 2 months.
authors.affiliation: Department of Radiology, Evanston Northwestern Healthcare, IL 60201, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Prager
authors.forename: Y
authors.initials: Y
authors.lastname: Grenier
authors.forename: J W
authors.initials: JW
authors.lastname: Cozzens
authors.forename: P
authors.initials: P
authors.lastname: Chiowanich
authors.forename: M T
authors.initials: MT
authors.lastname: Gorey
authors.forename: J R
authors.initials: JR
authors.lastname: Meyer
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D001672:Biocompatible Materials; D001927:Brain Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D002330:Carmustine / Q000008:administration & dosage*; D016503:Drug Delivery Systems; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D018906:Antineoplastic Agents, Alkylating; D001672:Biocompatible Materials; D002330:Carmustine