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Imaging |
Departments of Radiation Oncology (B.R.D., K.H., J.S.C.) and Neurosurgery (J.G.G., E.A.K., J.C.) and Division of Biostatistics (J.D.G., V.M.), New York University Medical Center, New York, NY 10016; Nassau Radiologic Group (S.C.R.), Garden City, NY 11530
2 Address correspondence to Bernadine Donahue, Department of Radiation Oncology, New York University Medical Center, 566 First Avenue, Room HC107, New York, NY 10016 (bernadine.donahue{at}med.nyu.edu).
Abstract
We investigated how frequently the imaging procedure we use immediately prior to radiosurgery— triple-dose gadolinium-enhanced MR performed with the patient immobilized in a nonrelocatable head frame and 1-mm-thick MPRAGE (magnetization-prepared rapid gradient echo) images (SRS3xGado)—identifies previously unrecognized cerebral metastases in patients initially imaged by conventional MR with single-dose gadolinium (1xGado). Between July 1998 and July 2000, the diagnoses established for 47 patients who underwent radio-surgical procedures for treatment of cerebral metastases at The Gamma Knife Center of New York University were based initially on the 1xGado protocol. In July 1998, we began using SRS3xGado as our routine imaging protocol in preparation for targeting lesions for radiosurgery, using triple-dose gadolinium and acquisition of contiguous 1-mm T1-weighted axial images. Because our SRS3xGado scans sometimes unexpectedly revealed additional metastases, we sought to learn how frequently the initial 1xGado scans would underestimate the number of metastases. We therefore reviewed the number of brain metastases identified on the SRS3xGado studies and compared the results to the number found by the 1xGado protocol, which had initially identified the brain metastases. Additional metastases, ranging from 1 to 23 lesions per patient, were identified on the SRS3xGado scan in 23 of 47 patients (49%). In 57% of the 23 patients, only one additional lesion was identified. The mean time interval between the 1xGado and the SRS3xGado scans was 20.6 days (range, 4 - 83 days), and the number of additional lesions detected and the time interval between two scans were negatively correlated (-0.11). The number of lesions detected on the SRS3xGado was associated only with the number of lesions on the 1xGado and not with any other patient or tumor pretreatment characteristics such as age, gender, largest tumor volume on the 1xGado, or number of days between the 1xGado and the SRS3xGado or prior surgery. The identification of additional lesions with SRS3xGado MR may have implications for patients who are treated with stereotactic radiosurgery alone (without whole-brain irradiation) with single-dose gadolinium imaging, in that unidentified lesions may go untreated. As a result of these findings we continue to use and advocate SRS3xGado scans for radiosurgery.
References
Alexander, E., 3rd, Moriarty, T.M., Davis, R.B., Wen, P.Y., Fine,
H.A., Black, P.M., Kooy, H.M., and Loeffler, J.S. (1995)
Stereotactic radiosurgery for the definitive, noninvasive treatment of brain
metastases. J. Natl. Cancer Inst.
87, 34-40.
Donahue, B., Golfinos, J.G., Rush, S., Han, K., Holland, B., and Cooper, J.S. (2000) Detection of additional brain metastases with triple dose gadolinium for stereotactic radiosurgery. Proc. 83rd Annu. Mtg. Am. Radium Soc. 25 (abstract #31).
Fellner, F., Lungenschmid, K., Fellner, C., Bohm-Jurkovic, C.H., and Bautz, W. (1998) Experiences with gadodiamide, a non-ionic contrast agent, in MRI of brain metastases. Rontgenpraxis 51,203 -211.[Medline]
Flickinger, J.C., Kondziolka, D., Lundsford, L.D., Coffey, R.J., Goodman, M.L., Shaw, E.G., Hudgins, W.R., Weiner, R., Harsh, G.R., 4th, Sneed, P.K., and Larson, D.A. (1994) A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int. J. Radiat. Oncol. Biol. Phys. 28,797 -802.[ISI][Medline]
Johnson, J.D., and Young, B. (1996) Demographics of brain metastases. Neurosurg. Clin. North Am. 7, 337-344.[ISI][Medline]
Knauth, M., Forsting, M., Hartmann, M., Heiland, S., Balzer, T., and Sartor, K. (1996) MR enhancement of brain lesions: Increased contrast dose compared with magnetization transfer. Am. J. Neuroradiol. 17,1853 -1859.[Abstract]
Knopp, E.A., Chandra, R., and Litt, A.W. (1993)MP-RAGE vs. T1 weighted SE imaging — a quantitative comparison of contrast enhanced lesion detectability . Presented at the Twelfth Annual Scientific Meeting of the Society of Magnetic Resonance Imaging in Medicine, Berkeley, Calif.
Mehta, M.P., Rozental, J.M., Levin, A.B., Mackie, TR., Kubsad, S.S., Gehring, M.A., and Kinsella, T.J. (1992) Defining the role of radiosurgery in the management of brain metastases. Int. J. Radiat. Oncol. Biol. Phys. 24,619 -625.[ISI][Medline]
Nieder, C., Berberich, W., and Schnabel, K. (1997) Tumor-related prognostic factors for remission of brain metastases after radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 39, 25-30.[CrossRef][ISI][Medline]
Patchell, R.A., Tibbs, P.A., Regine, W.F., Dempsy, R.J., Mohiuddin,
M., Kryscio, R.J., Markesbery, W.R., Foon, K.A., and Young, B.
(1998) Post-operative radiotherapy in the treatment of single
metastases to the brain: A randomized trial. JAMA
280,1485
-1489.
Sanghavi, S.N., Miranpuri, S.S., Chappell, R., Mabanta, S., Suh, J.H., Regine, W.F., Weltman, E., Sneed, P.K., Goetsch, S.J., Breneman, J.C, Sperduto, P.W., Scott, C., Buatti, J.M., and Mehta, M.P. (1999) Multi-institutional survival analysis of brain metastases patients treated with radiosurgery, stratified by RTOG RPA Classification (Proceedings of the 41st Annual ASTRO Meeting). Int. J. Radiat. Oncol. Biol. Phys. 45,171 .[ISI][Medline]
Sperduto, P.W., Scott, C., Andrews, D., Schell, M.C., Flanders, A., Werner-Wasik, M., Demas, W., Ryu, J.K., Gaspar, L.E., Bahary, J., Souhami, L., Rotman, M., and Curran, W.J. (2002) Stereotactic radiosurgery with whole brain radiation therapy improves survival in patients with brain metastases: Report of Radiation Therapy Oncology Group phase III study 95-08 (abstract) (Proceedings of the 44th Annual ASTRO Meeting). Int. J. Radiat. Oncol. Biol. Phys. 54,3 .
Sze, G., Johnson, C., Kawamura, Y., Goldberg, S.N., Lanage, R., Friedland, R.J., and Wolf, R.J. (1998) Comparison of single- and triple-dose contrast material in the MR screening of brain metastases. Am. J. Neuroradiol. 19,829 -828.[ISI][Medline]
Thng, C.H., Tay, K.H., Chan, L.L., Lim, E.H., Khoo, B.K., Huin, E.L., and Tan, K.P. (1999) Magnetic resonance imaging of brain metastases: Magnetisation transfer or triple dose gadolinium? Ann. Acad. Med. Singapore 28,529 -533.[Medline]
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