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Differentiating Radiation-Induced Necrosis from Tumor Progression After Stereotactic Radiosurgery for Brain Metastases, Using Evaluation of Blood Flow with Arterial Spin Labeling (ASL): The Importance of Setting a Baseline

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Gamma Knife Neurosurgery in the Management of Intracranial Disorders II

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 128))

Abstract

Objective: This study evaluated the usefulness of arterial spin labeling (ASL) for assessment of tumor blood flow (TBF) and cerebral blood flow (CBF) before Gamma Knife surgery (GKS) for intracranial metastases, in order to analyze the variability of perfusion characteristics at baseline and to reveal how these data may impact differentiation of radiation-induced effects from tumor progression during follow-up.

Methods: Radiological data from 87 patients with intracranial metastases of solid cancers, who underwent TBF/CBF analysis by means of ASL at the Hawaii Advanced Imaging Institute between 2015 and 2018 both before and after GKS, were reviewed retrospectively. Only cases with a largest tumor diameter of ≥10 mm were included in the study cohort (N = 53).

Results: In comparison with CBF in the healthy contralateral cerebral cortex, TBF before GKS was greater in 32 cases (60%), lesser in 7 cases (13%), and equivalent in 14 cases (27%). There was significant variability in TBF both within and between histologically different groups of tumors.

Conclusion: Since, at baseline, approximately 40% of intracranial metastases have TBF that is lesser or equivalent to CBF, increased blood flow in the contrast-enhancing lesion after GKS may have insufficient sensitivity for identification of tumor progression. Availability of baseline TBF data may significantly facilitate differential diagnosis in such cases.

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Authors and Affiliations

  1. St. George’s, University of London at University of Nicosia, Nicosia, Cyprus

    Elle A. Lambert

  2. InVision Imaging, Honolulu, HI, USA

    Stephen Holmes

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  1. Elle A. Lambert
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Correspondence to Stephen Holmes .

Editor information

Editors and Affiliations

  1. Faculty of Advanced Techno-Surgery and Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Mikhail F. Chernov

  2. Gamma Knife Unit, Department of Neurosurgery, and Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Tokyo, Japan

    Motohiro Hayashi

  3. Department of Neurosurgery, University of Minnesota Medical School, Minnesota, MN, USA

    Clark C. Chen

  4. Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Ian E. McCutcheon

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Lambert, E.A., Holmes, S. (2021). Differentiating Radiation-Induced Necrosis from Tumor Progression After Stereotactic Radiosurgery for Brain Metastases, Using Evaluation of Blood Flow with Arterial Spin Labeling (ASL): The Importance of Setting a Baseline. In: Chernov, M.F., Hayashi, M., Chen, C.C., McCutcheon, I.E. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders II. Acta Neurochirurgica Supplement, vol 128. Springer, Cham. https://doi.org/10.1007/978-3-030-69217-9_12

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  • DOI: https://doi.org/10.1007/978-3-030-69217-9_12

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