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Recurrent glioblastoma multiforme versus radiation injury: a multiparametric 3-T MR approach

La radiologia medica volume 119, pages 616–624 (2014)Cite this article

Abstract

Objective

The discrimination between recurrent glioma and radiation injury is often a challenge on conventional magnetic resonance imaging (MRI). We verified whether adding and combining proton MR spectroscopic imaging (1H-MRSI), diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) information at 3 Tesla facilitate such discrimination.

Materials and methods

Twenty-nine patients with histologically verified high-grade gliomas, who had undergone surgical resection and radiotherapy, and had developed new contrast-enhancing lesions close to the treated tumour, underwent MRI, 1H-MRSI, DWI and PWI at regular time intervals. The metabolite ratios choline (Cho)/normal( n )Cho n , N-acetylaspartate (NAA)/NAA n , creatine (Cr)/Cr n , lactate/lipids (LL)/LL n , Cho/Cr n , NAA/Cr n , Cho/NAA, NAA/Cr and Cho/Cr were derived from 1H-MRSI; the apparent diffusion coefficient (ADC) from DWI; and the relative cerebral blood volume (rCBV) from PWI.

Results

In serial MRI, recurrent gliomas showed a progressive enlargement, and radiation injuries showed regression or no modification. Discriminant analysis showed that discrimination accuracy was 79.3 % when considering only the metabolite ratios (predictor, Cho/Cr n ), 86.2 % when considering ratios and ADC (predictors, Cho/Cr n and ADC), 89.7 % when considering ratios and rCBV (predictors, Cho/Cr n , Cho/Cr and rCBV), and 96.6 % when considering ratios, ADC and rCBV (predictors, Cho/Cho n , ADC and rCBV).

Conclusions

The multiparametric 3-T MR assessment based on 1H-MRSI, DWI and PWI in addition to MRI is a useful tool to discriminate tumour recurrence/progression from radiation effects.

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Acknowledgments

The authors are grateful to Italia Di Maggio, Giovanni Miscio and Piero Ghedin for expert technical assistance.

Conflict of interest

Alfonso Di Costanzo, Tommaso Scarabino, Francesca Trojsi, Teresa Popolizio, Simona Bonavita, Mario de Cristofaro, Renata Conforti, Adriana Cristofano, Claudio Colonnese, Ugo Salvolini, Gioacchino Tedeschi declare no conflict of interest.

Author information

Affiliations

  1. Dipartimento di Medicina e Scienze per la Salute, Università del Molise, Via De Sanctis snc, 86100, Campobasso, Italy

    Alfonso Di Costanzo & Adriana Cristofano

  2. Dipartimento di Neuroscienze, IRCCS Neuromed, Pozzilli, IS, Italy

    Alfonso Di Costanzo & Adriana Cristofano

  3. U.O. di Neuroradiologia, AUSL BAT, Ospedale Lorenzo Bonomo, Andria, Italy

    Tommaso Scarabino

  4. Dipartimento di Neuroradiologia, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG, Italy

    Tommaso Scarabino & Teresa Popolizio

  5. Dipartimento di Neuroscienze, Seconda Università di Napoli, Naples, Italy

    Francesca Trojsi, Simona Bonavita, Mario de Cristofaro & Gioacchino Tedeschi

  6. Istituto di Diagnosi e Cura ‘‘Hermitage Capodimonte’’, Naples, Italy

    Francesca Trojsi, Simona Bonavita, Mario de Cristofaro & Gioacchino Tedeschi

  7. Dipartimento di Medicina Clinica e Sperimentale, Seconda Università di Napoli, Naples, Italy

    Renata Conforti

  8. Dipartimento di Neuroradiologia, IRCCS Neuromed, Pozzilli, IS, Italy

    Claudio Colonnese

  9. Dipartimento di Radiologia, Università Politecnica delle Marche, Ancona, Italy

    Ugo Salvolini

Authors
  1. Alfonso Di Costanzo
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  2. Tommaso Scarabino
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  3. Francesca Trojsi
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  4. Teresa Popolizio
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  8. Adriana Cristofano
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  9. Claudio Colonnese
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  11. Gioacchino Tedeschi
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Correspondence to Alfonso Di Costanzo.

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Di Costanzo, A., Scarabino, T., Trojsi, F. et al. Recurrent glioblastoma multiforme versus radiation injury: a multiparametric 3-T MR approach. Radiol med 119, 616–624 (2014). https://doi.org/10.1007/s11547-013-0371-y

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  • DOI: https://doi.org/10.1007/s11547-013-0371-y

Keywords

  • Radiation injury
  • Recurrent brain tumour
  • Magnetic resonance spectroscopy
  • Diffusion-weighted imaging
  • Perfusion-weighted imaging