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23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note

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Abstract

Introduction

We report the first case of an intraoperative radiotherapy (IORT) in a patient with recurrent glioblastoma multiforme (GBM) who was followed up with a novel magnetic resonance imaging (MRI) method—23Na-MRI—in comparison to a standard contrast-enhanced 1H-MRI and 18F-FET-PET.

Methods

A 56-year-old female patient with diagnosed GBM in July 2012 underwent tumor resection, radiochemotherapy, and three cycles of chemotherapy. After a relapse, 6 months after the initial diagnosis, an IORT was recommended which was performed in March 2013 using the INTRABEAM system (Carl Zeiss Meditec AG, Germany) with a 3-cm applicator and a surface dose of 20 Gy. Early post-operative contrast-enhanced and 1-month follow-up 1H-MRI and a 18F-FET-PET were performed. In addition, an IRB-approved 23Na-MRI was performed on a 3.0-T MR scanner (MAGNETOM TimTrio, Siemens Healthcare, Germany).

Results

After re-surgery and IORT in March 2013, only a faint contrast enhancement but considerable surrounding edema was visible at the medio-posterior resection margins. In April 2013, new and progressive contrast enhancement, edema, 23Na content, and increased uptake in the 18F-FET-PET were visible, indicating tumor recurrence. Increased sodium content within the area of contrast enhancement was found in the 23Na-MRI, but also exceeding this area, very similar to the increased uptake depicted in the 18F-FET-PET. The clearly delineable zone of edema in both examinations exhibits a lower 23Na content compared to areas with suspected proliferating tumor tissue.

Conclusion

23Na-MRI provided similar information in the suspicious area compared to 18F-FET-PET, exceeding conventional 1H-MRI. Still, 23Na-MRI remains an investigational technique, which is worth to be further evaluated.

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Ethical standards and patient consent

We declare that all human studies have been approved by the Institutional Review Board and Ethics Commitee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Stefan Haneder, Karen A. Buesing, Stefan O. Schoenberg & Melissa M. Ong

  2. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

    Frank A. Giordano & Frederik Wenz

  3. Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany

    Simon Konstandin & Lothar R. Schad

  4. Department of Neurosurgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany

    Stefanie Brehmer & Peter Schmiedek

Authors
  1. Stefan Haneder
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  2. Frank A. Giordano
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  3. Simon Konstandin
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  4. Stefanie Brehmer
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  5. Karen A. Buesing
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  6. Peter Schmiedek
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  7. Lothar R. Schad
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  8. Frederik Wenz
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  9. Stefan O. Schoenberg
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  10. Melissa M. Ong
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Corresponding author

Correspondence to Melissa M. Ong.

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Haneder, S., Giordano, F.A., Konstandin, S. et al. 23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note. Neuroradiology 57, 321–326 (2015). https://doi.org/10.1007/s00234-014-1468-2

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  • DOI: https://doi.org/10.1007/s00234-014-1468-2

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