Skip to main content

Advertisement

SpringerLink
Log in

Histopathological correlation of brain tumor recurrence vs. radiation effect post-radiosurgery as detected by MRI contrast clearance analysis: a validation study

  • Case Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

The differentiation between adverse radiation effects (ARE) and tumor recurrence or progression (TRP) is a major decision-making point in the follow-up of patients with brain tumors. The advent of immunotherapy, targeted therapy and radiosurgery has made this distinction difficult to achieve in several clinical situations. Contrast clearance analysis (CCA) is a useful technique that can inform clinical decisions but has so far only been histologically validated in the context of high-grade gliomas.

Methods

This is a series of 7 patients, treated between 2018 and 2023, for various brain pathologies including brain metastasis, atypical meningioma, and high-grade glioma. MRI with contrast clearance analysis was used to inform clinical decisions and patients underwent surgical resection as indicated. The histopathology findings were compared with the CCA findings in all cases.

Results

All seven patients had been treated with gamma knife radiosurgery and were followed up with periodic MR imaging. All patients underwent CCA when the necessity to distinguish tumor recurrence from radiation necrosis arose, and subsequently underwent surgery as indicated. Concordance of CCA findings with histological findings was found in all cases (100%).

Conclusions

Based on prior studies on GBM and the surgical findings in our series, delayed contrast extravasation MRI findings correlate well with histopathology across a wide spectrum of brain tumor pathologies. CCA can provide a quick diagnosis and have a direct impact on patients’ treatment and outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

ARE:

Adverse radiation effect

BEV:

Bevacizumab

CCA:

Contrast clearance analysis

GKRS:

Gamma Knife Radiosurgery

IDL:

Isodose line

IMRT:

Intensity modulated radiotherapy

TRP:

Tumor recurrence/progression

References

  1. Langer CJ, Mehta MP (2005) Current management of brain metastases, with a focus on systemic options. J Clin Oncol 23:6207–6219. https://doi.org/10.1200/JCO.2005.03.145

    Article  CAS  PubMed  Google Scholar 

  2. Yu Y, Chen H, Tian Z, Zhang Q, Shui Y, Shen L, Hu Q, Huang Z, Zhu S, Jiang H, Wei Q (2023) Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases. J Neurooncol 165:127–137. https://doi.org/10.1007/s11060-023-04459-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Zach L, Guez D, Last D, Daniels D, Grober Y, Nissim O, Hoffmann C, Nass D, Talianski A, Spiegelmann R, Tsarfaty G, Salomon S, Hadani M, Kanner A, Blumenthal DT, Bukstein F, Yalon M, Zauberman J, Roth J, Shoshan Y, Fridman E, Wygoda M, Limon D, Tzuk T, Cohen ZR, Mardor Y (2015) Delayed contrast extravasation MRI: a new paradigm in neuro-oncology. Neuro Oncol 17:457–465. https://doi.org/10.1093/neuonc/nou230

    Article  CAS  PubMed  Google Scholar 

  4. Ellingson BM, Chung C, Pope WB, Boxerman JL, Kaufmann TJ (2017) Pseudoprogression, radionecrosis, inflammation or true tumor progression? Challenges associated with Glioblastoma response assessment in an evolving therapeutic landscape. J Neurooncol 134:495–504. https://doi.org/10.1007/s11060-017-2375-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Manning P, Daghighi S, Rajaratnam MK, Parthiban S, Bahrami N, Dale AM, Bolar D, Piccioni DE, McDonald CR, Farid N (2020) Differentiation of progressive disease from pseudoprogression using 3D PCASL and DSC perfusion MRI in patients with glioblastoma. J Neurooncol 147:681–690. https://doi.org/10.1007/s11060-020-03475-y

    Article  PubMed  Google Scholar 

  6. Thomas AA, Arevalo-Perez J, Kaley T, Lyo J, Peck KK, Shi W, Zhang Z, Young RJ (2015) Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma. J Neurooncol 125:183–190. https://doi.org/10.1007/s11060-015-1893-z

    Article  PubMed  PubMed Central  Google Scholar 

  7. Umemura Y, Wang D, Peck KK, Flynn J, Zhang Z, Fatovic R, Anderson ES, Beal K, Shoushtari AN, Kaley T, Young RJ (2020) DCE-MRI perfusion predicts pseudoprogression in metastatic melanoma treated with immunotherapy. J Neurooncol 146:339–346. https://doi.org/10.1007/s11060-019-03379-6

    Article  CAS  PubMed  Google Scholar 

  8. Bodensohn R, Forbrig R, Quach S, Reis J, Boulesteix AL, Mansmann U, Hadi I, Fleischmann DF, Mucke J, Holzgreve A, Albert NL, Ruf V, Dorostkar M, Corradini S, Herms J, Belka C, Thon N, Niyazi M (2022) MRI-based contrast clearance analysis shows high differentiation accuracy between radiation-induced reactions and progressive disease after cranial radiotherapy. ESMO Open 7:100424. https://doi.org/10.1016/j.esmoop.2022.100424

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lim DH, Kim SY, Na YC, Cho JM (2023) Navigation guided Biopsy is as effective as Frame-based stereotactic biopsy. J Pers Med 13. https://doi.org/10.3390/jpm13050708

  10. Mohamedkhan S, Hindocha S, de Boisanger J, Millard T, Welsh L, Rich P, MacKinnon AD, Williams N, Sharma B, Rosenfelder N, Minchom A (2024) Contrast Clearance Analysis (CCA) to assess viable Tumour following stereotactic radiosurgery (SRS) to Brain Metastasis in Non-small Cell Lung Cancer (NSCLC). Cancers (Basel) 16. https://doi.org/10.3390/cancers16061218

  11. Zach L, Guez D, Last D, Daniels D, Grober Y, Nissim O, Hoffmann C, Nass D, Talianski A, Spiegelmann R, Cohen ZR, Mardor Y (2012) Delayed contrast extravasation MRI for depicting tumor and non-tumoral tissues in primary and metastatic brain tumors. PLoS ONE 7:e52008. https://doi.org/10.1371/journal.pone.0052008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Rachinger W, Stoecklein VM, Terpolilli NA, Haug AR, Ertl L, Poschl J, Schuller U, Schichor C, Thon N, Tonn JC (2015) Increased 68Ga-DOTATATE uptake in PET imaging discriminates meningioma and tumor-free tissue. J Nucl Med 56:347–353. https://doi.org/10.2967/jnumed.114.149120

    Article  CAS  PubMed  Google Scholar 

  13. Chen WC, Perlow HK, Choudhury A, Nguyen MP, Mirchia K, Youngblood MW, Lucas CG, Palmer JD, Magill ST, Raleigh DR (2022) Radiotherapy for meningiomas. J Neurooncol 160:505–515. https://doi.org/10.1007/s11060-022-04171-9

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding for this work was provided.

Author information

Authors and Affiliations

  1. Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Victor Goulenko, Venkatesh Shankar Madhugiri & Dheerendra Prasad

  2. Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Lindsay Lipinski, Andrew Fabiano, Robert Fenstermaker, Robert Plunkett & Dheerendra Prasad

  3. Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA

    Amade Bregy, Matthew Recker, Robert Plunkett & Dheerendra Prasad

  4. Department of Neuro-oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Ajay Abad & Dheerendra Prasad

  5. Department of Diagnostic Imaging, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Ahmed Belal & Ronald Alberico

  6. Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Jingxin Qiu

  7. Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, 14203, Buffalo, NY, USA

    Dheerendra Prasad

Authors
  1. Victor Goulenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Venkatesh Shankar Madhugiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amade Bregy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew Recker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lindsay Lipinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew Fabiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert Fenstermaker
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert Plunkett
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ajay Abad
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ahmed Belal
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ronald Alberico
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jingxin Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Dheerendra Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Victor Goulenko– conceptualization, data acquisition, data analysis, writing, review. Venkatesh S Madhugiri– conceptualization, data acquisition, data analysis, writing, review. Amade Bregdy - data acquisition, data analysis, writing, review. Matthew Recker– data analysis, writing, review. Jingxin Qiu– data acquisition, data analysis, writing, review. Lindsey Lipinsky– data acquisition, data analysis, writing, review. Andrew Fabiano– data acquisition, data analysis, writing, review. Robert Fenstermaker– data acquisition, data analysis, writing, review. Robert Plunkett– data acquisition, data analysis, writing, review. Dheerendra Prasad– conceptualization, data acquisition, data analysis, writing, review.

Corresponding author

Correspondence to Dheerendra Prasad.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by the Institutional Review Board of Roswell Park Comprehensive Cancer Center.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goulenko, V., Madhugiri, V.S., Bregy, A. et al. Histopathological correlation of brain tumor recurrence vs. radiation effect post-radiosurgery as detected by MRI contrast clearance analysis: a validation study. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04697-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11060-024-04697-0

Keywords

Search

Navigation