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Evaluation of serial changes on computed tomography and magnetic resonance imaging after implantation of carmustine wafers in patients with malignant gliomas for differential diagnosis of tumor recurrence

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Abstract

Carmustine wafers are approved for localized treatment of malignant glioma. In this study, overall changes in computed tomography (CT) and magnetic resonance (MR) images of malignant glioma patients treated with carmustine wafer implantation were evaluated. The subjects were 25 patients undergoing craniotomy for malignant glioma resection and carmustine wafer implantation. Changes in the appearance of wafers, the resection cavity, and the adjacent parenchyma on CT and MR imaging were evaluated retrospectively. On CT, the wafers changed from an initially high-dense to an iso-dense appearance. All MR studies showed a low-intense wafer within 2 days. The wafers changed to a high- or iso-intense appearance on fluid attenuated inversion recovery and T1-weighted imaging, whereas they changed to an iso- to low-intense appearance on T2-weighted imaging. Gas in the cavity increased gradually after surgery, achieved a peak at 1 week postoperatively, and then disappeared in 1–3 months. Increased volume of the resection cavity was observed in 48 % of patients. Regarding changes in the adjacent parenchyma, obvious contrast enhancement at the wall of the resection cavity was seen in 91 % of cases at 1 month, but this disappeared gradually. Edema around the resection cavity was increased in 7 patients (28 %), of whom only two experienced symptoms due to edema. We conclude that these radiological changes after carmustine wafer implantation should be carefully followed up, because these changes can easily be mistaken for infectious disease or recurrent tumors.

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Compliance with Ethical Standards

The authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Departments of Neurosurgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan

    Shiro Ohue, Shohei Kohno, Akihiro Inoue, Daisuke Yamashita, Satoshi Suehiro, Toshimoto Seno & Takanori Ohnishi

  2. Departments of Regeneration of Community Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan

    Yoshiaki Kumon

  3. Departments of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan

    Keiichi Kikuchi

Authors
  1. Shiro Ohue
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  2. Shohei Kohno
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  3. Akihiro Inoue
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  4. Daisuke Yamashita
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  5. Satoshi Suehiro
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  6. Toshimoto Seno
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  7. Yoshiaki Kumon
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  8. Keiichi Kikuchi
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  9. Takanori Ohnishi
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Correspondence to Shiro Ohue.

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Ohue, S., Kohno, S., Inoue, A. et al. Evaluation of serial changes on computed tomography and magnetic resonance imaging after implantation of carmustine wafers in patients with malignant gliomas for differential diagnosis of tumor recurrence. J Neurooncol 126, 119–126 (2016). https://doi.org/10.1007/s11060-015-1941-8

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  • DOI: https://doi.org/10.1007/s11060-015-1941-8

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