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Serial CT and MR Imaging of Carmustine Wafers

Jordan M. PragerGo,a, Yannick Greniera, Jeffrey W. Cozzensa, Pong Chiowanicha, Michael T. Goreya and Joel R. Meyera

a From the Departments of Radiology (J.M.P., J.R.M., P.C., M.T.G.) and Neurosurgery (J.W.C.), Evanston Northwestern Healthcare, Evanston, IL; and the Department of Neurosurgery, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, IL (Y.G.).



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  		FIG 1. Biodegradable wafer: diameter, 1.4 cm; thickness, 1 mm



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  		FIG 2. CT scan obtained less than 24 hours after surgery shows four clearly defined wafers. One wafer has an unusual appearance, half-increased attenuation and half-decreased attenuation (arrow)



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  		FIG 3. CT study.

A, Less than 24 hours after surgery, two well-defined wafers are seen.

B, Follow-up study at 2 months shows faint wafer remnants (arrows).



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  		FIG 4. <-MR study.

A–C, T1-weighted (A), T2-weighted (B), and contrast-enhanced T1-weighted (C) images less than 24 hours after surgery show three well-defined, decreased-signal wafers (arrows, A). There is no enhancement; subtle increased T1 signal is visible in the operative bed.

D–F, T1-weighted (D), T2-weighted (E), and contrast-enhanced T1-weighted (F) images 1 week after surgery show resolving postoperative changes with decreased edema, mass effect, and intracranial gas. The wafers are still easily seen but are somewhat less distinct.

G–I, T1-weighted (G), T2-weighted (H), and contrast-enhanced T1-weighted (I) images 2 months after surgery. The wafers have increased signal on T1-weighted image (arrows, G) and less prominent decreased signal on T2-weighted image. There is enhancement of the operative bed and in the parenchyma.

J–L, T1-weighted (J), T2-weighted (K), and contrast-enhanced T1-weighted (L) images 5 months after surgery show increased T2 signal abnormality in the brain. Incomplete wafer remnants are seen on T2-weighted image only (arrows, K). After contrast administration, marked increased enhancement is seen in operative bed and parenchyma (L).



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Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X