title: Distinguishing recurrent primary brain tumor from radiation injury: a preliminary study using a susceptibility-weighted MR imaging-guided apparent diffusion coefficient analysis strategy.
abstract: OBJECTIVE
  The accurate delineation of tumor recurrence presents a significant problem in neuro-oncology. Our aim was to improve the identification of brain tumor recurrence from chemoradiation injury by using CE-SWI, a technique that provides improved visualization of the heterogeneous patterns of brain tumor pathology, to guide the analysis of ADC measures within the peritumoral territory.
  
  
  METHODS
  Seventeen patients who were being treated for high-grade glial neoplasms took part in the study. All patients presented with new enhancing lesions on follow-up CE-T1. Recurrence or chemoradiation injury was confirmed from either histologic analysis or extensive clinical follow-up. Regions of enhancement on registered CE-SWI and CE-T1 images were extracted in a semiautomated fashion and transferred to co-registered ADC maps. Significant differences in ADC measures defined within the enhancement volumes on serial MR images were analyzed by using a nonparametric Kolmogorov-Smirnov approach and correlated with clinical follow-up diagnoses.
  
  
  RESULTS
  Analysis of the serial data revealed that patients with a diagnosis of tumor recurrence had significantly reduced ADC measures within the enhancement volume delineated on CE-SWI. In contrast, patients with SD had significantly elevated ADC within the CE-SWI enhancement volume.
  
  
  CONCLUSIONS
  The findings of an increase in enhancement volume delineated on serial CE-SWI maps, along with a concomitant reduction in ADC within this volume for patients with recurrent tumor, provide support for such an approach to be used to assist in follow-up patient management strategies.
authors.affiliation: Centre for Magnetic Resonance, University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Al Sayyari
authors.forename: R
authors.initials: R
authors.lastname: Buckley
authors.forename: C
authors.initials: C
authors.lastname: McHenery
authors.forename: K
authors.initials: K
authors.lastname: Pannek
authors.forename: A
authors.initials: A
authors.lastname: Coulthard
authors.forename: S
authors.initials: S
authors.lastname: Rose
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001254:Astrocytoma / Q000473:pathology / Q000532:radiotherapy; D001932:Brain Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009837:Oligodendroglioma / Q000473:pathology / Q000532:radiotherapy; D010865:Pilot Projects; D011832:Radiation Injuries / Q000473:pathology*