title: Diffusion restriction in a non-enhancing metastatic brain tumor treated with bevacizumab - recurrent tumor or atypical necrosis?
abstract: A 38-year-old female with metastatic brain cancer developed non-enhancing, diffusion restricted lesions following bevacizumab treatment. From our review of the literature, this is the first reported case of this type of lesion. Clinicians should be wary of these lesions, as they can represent either tumor progression or necrosis/effects of chronic hypoxia from anti-angiogenic therapy. Further investigation is necessary to determine the biological mechanism and clinical significance of this type of imaging appearance.
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC. Electronic address: sivasund@usc.edu.
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Sivasundaram
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC.
authors.forename: Saman
authors.initials: S
authors.lastname: Hazany
authors.affiliation: Department of Neurology, Keck School of Medicine of USC.
authors.forename: Naveed
authors.initials: N
authors.lastname: Wagle
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine of USC.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zada
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine of USC.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Chen
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lerner
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC.
authors.forename: John L
authors.initials: JL
authors.lastname: Go
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amore
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC.
authors.forename: Meng
authors.initials: M
authors.lastname: Law
authors.affiliation: Division of Neuroradiology, Department of Radiology, Keck School of Medicine of USC.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Shiroishi
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000556:secondary*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009336:Necrosis / Q000175:diagnosis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009778:Occipital Lobe / Q000473:pathology*; D010296:Parietal Lobe / Q000473:pathology*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: Atypical necrosis; Bevacizumab; Brain metastases; DWI; Recurrent tumor