Radiation Necrosis Versus Glioma Recurrence: Conventional MR Imaging Clues to Diagnosis
Mark E. Mullinsa,b,
Glenn D. Barestc,d,
Pamela W. Schaefera,b,
Fred H. Hochbergb,e,f,
R. Gilberto Gonzaleza and
Michael H. Leva,b
a Department of Radiology, Massachusetts General Hospital, Boston, MA
b Harvard Medical School, Boston, MA
c Boston University Medical Center, Boston, MA
d Boston University Medical School, Boston, MA
e Department of Neurology, Massachusetts General Hospital, Boston, MA
f Brain Tumor Center, Massachusetts General Hospital, Boston, MA
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FIG 1. 60-year-old woman with a history of left parietal anaplastic astrocytoma and new abnormal enhancement on follow-up imaging after surgery and proton beam irradiation therapy. Arrows on this postcontrast axial T1-weighted image illustrate the "spreading wavefront" appearance. Biopsy of this lesion yielded radiation necrosis.
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FIG 2. 50-year-old woman with history of left parieto-temporo-occipital glioblastoma multiforme and new abnormal enhancement on follow-up imaging after surgery and proton beam irradiation therapy. A, Arrows on this precontrast axial T1-weighted image illustrate the location of abnormal enhancement. B, Arrows on this postcontrast axial T1-weighted image illustrate the spreading wavefront appearance along one of the dominant borders of the lesion; subependymal involvement that extended up to involve the corpus callosum is also observed. Biopsy of a portion of the abnormality yielded recurrent tumor.
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FIG 3. 57-year-old woman with history of right frontal glioblastoma multiforme and new abnormal enhancement on follow-up imaging after surgery and proton beam irradiation therapy. A, Arrows on this postcontrast axial T1-weighted image illustrate multiple enhancing lesions and spread to the contralateral hemisphere. B, Arrows on this postcontrast axial T2-weighted image illustrate the location of abnormal enhancement on the axial T1-weighted images, as well as associated vasogenic or tumor edema. Biopsy of a portion of the abnormality yielded recurrent tumor.
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FIG 4. 68-year-old man with history of left parietooccipital glioblastoma multiforme has new abnormal enhancement on follow-up imaging after surgery and proton beam irradiation therapy. Arrows on this postcontrast axial T1-weighted image illustrate enhancement and thickening of the septum pellucidum. Arrowhead points to involvement of the corpus callosum. Open arrow points to subependymal spread. Multiple new lesions were identified. Biopsy of a portion of the corpus callosum abnormality (arrowhead) yielded recurrent tumor.
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