title: Toward distinguishing recurrent tumor from radiation necrosis: DWI and MTC in a Gamma Knife--irradiated mouse glioma model.
abstract: OBJECTIVE
  Accurate noninvasive diagnosis is vital for effective treatment planning. Presently, standard anatomical magnetic resonance imaging (MRI) is incapable of differentiating recurring tumor from delayed radiation injury, as both lesions are hyperintense in both postcontrast T1- and T2-weighted images. Further studies are therefore necessary to identify an MRI paradigm that can differentially diagnose these pathologies. Mouse glioma and radiation injury models provide a powerful platform for this purpose.
  
  
  METHODS
  Two MRI contrasts that are widely used in the clinic were chosen for application to a glioma/radiation-injury model: diffusion weighted imaging, from which the apparent diffusion coefficient (ADC) is obtained, and magnetization transfer contrast, from which the magnetization transfer ratio (MTR) is obtained. These metrics were evaluated longitudinally, first in each lesion type alone-glioma versus irradiation - and then in a combined irradiated glioma model.
  
  
  RESULTS
  MTR was found to be consistently decreased in all lesions compared to nonlesion brain tissue (contralateral hemisphere), with limited specificity between lesion types. In contrast, ADC, though less sensitive to the presence of pathology, was increased in radiation injury and decreased in tumors. In the irradiated glioma model, ADC also increased immediately after irradiation, but decreased as the tumor regrew.
  
  
  CONCLUSIONS
  ADC is a better metric than MTR for differentiating glioma from radiation injury. However, MTR was more sensitive to both tumor and radiation injury than ADC, suggesting a possible role in detecting lesions that do not enhance strongly on T1-weighted images.
authors.affiliation: Department of Radiology, Washington University, St. Louis, Missouri.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Perez-Torres
authors.affiliation: Department of Radiology, Washington University, St. Louis, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Engelbach
authors.affiliation: Department of Radiation Oncology, Washington University, St. Louis, Missouri.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cates
authors.affiliation: Department of Radiation Oncology, Washington University, St. Louis, Missouri.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Thotala
authors.affiliation: Department of Neurosurgery, Washington University, St. Louis, Missouri.
authors.forename: Liya
authors.initials: L
authors.lastname: Yuan
authors.affiliation: Department of Neuropathology, Washington University, St. Louis, Missouri.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmidt
authors.affiliation: Department of Radiation Oncology, Washington University, St. Louis, Missouri; Department of Neurosurgery, Washington University, St. Louis, Missouri.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Rich
authors.affiliation: Department of Radiation Oncology, Washington University, St. Louis, Missouri.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Drzymala
authors.affiliation: Department of Chemistry, Washington University, St. Louis, Missouri; Department of Radiology, Washington University, St. Louis, Missouri; Department of Internal Medicine, Washington University, St. Louis, Missouri.
authors.forename: Joseph J H
authors.initials: JJ
authors.lastname: Ackerman
authors.affiliation: Department of Radiology, Washington University, St. Louis, Missouri. Electronic address: garbow@wustl.edu.
authors.forename: Joel R
authors.initials: JR
authors.lastname: Garbow
mesh_terms: D000818:Animals; D001921:Brain / Q000473:pathology* / Q000528:radiation effects; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004195:Disease Models, Animal; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D051379:Mice; D008807:Mice, Inbred BALB C; D009336:Necrosis / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D011832:Radiation Injuries / Q000175:diagnosis* / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects; D012680:Sensitivity and Specificity
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