Quantitative MR Perfusion for the Differentiation of Recurrence and Radionecrosis in Hypoperfusion and Hyperperfusion Brain Metastases After Gamma Knife Radiosurgery

Yang Yunqi; Niu Aihua; Zheng Zhiming; Liu Yingchao; Wang Qiang; Ming Yang; Zhang Yi

doi:10.3389/fneur.2022.823731

Quantitative MR Perfusion for the Differentiation of Recurrence and Radionecrosis in Hypoperfusion and Hyperperfusion Brain Metastases After Gamma Knife Radiosurgery

Front Neurol. 2022 Mar 18:13:823731. doi: 10.3389/fneur.2022.823731. eCollection 2022.

Authors

Yang Yunqi¹, Niu Aihua², Zheng Zhiming², Liu Yingchao², Wang Qiang³, Ming Yang⁴, Zhang Yi⁵

Affiliations

¹ Department of Neurosurgery, Dongming People's Hospital, Heze, China.
² Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
³ Department of Human Resources, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
⁴ Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
⁵ Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

Abstract

Objectives: Dynamic susceptibility contrast perfusion weighted imaging (DSC-PWI) plays an important role in the differential diagnosis between radionecrosis and recurrence of brain metastases (BMs) after gamma knife radiosurgery (GKRS). While the perfusion condition of preliminary hyperperfusion and hypoperfusion BMs when recur has not been studied, as well the separating performance of quantitative DSC-PWI in both kinds of BMs.

Methods: From February 2017 to October 2019, quantitative DSC-PWI was performed in patients with untreated BMs in this observational study. Patients were assigned to hyperperfusion and hypoperfusion group according the quantitative cerebral blood volume (qCBV). During follow-up after GKRS, patients with a diagnostic pitfall of radionecrosis and recurrence accepted second quantitative DSC-PWI. Final diagnosis was based on the histological results or follow-up results. Receiver operating curve analysis was used to explore the performance of qCBV.

Results: Twenty-nine patients (mean age: 61.3 ± 9.4 years old; male/female: 13/16) were assigned to the group of hypoperfusion group, and 26 patients (mean age: 58 ± 10.4 years old; male/female: 14/12) to hyperperfusion group. The mean qCBV values between hypoperfusion and hyperperfusion groups when recurred were not significantly different (3.17 ± 0.53 ml/100 g vs. 3.27 ± 0.47 ml/100 g, p = 0.63). qCBV was feasible to separate radionecrosis and recurrence in both groups (AUC=0.94 and AUC=0.93, separately).

Conclusion: Both premilitary hyperperfusion and hypoperfusion BMs would transform to a high microvascular density when recurs. qCBV is feasible to distinguish radionecrosis and recurrence among both kinds of BMs after GKRS.

Keywords: MR perfusion; brain metastases (BMs); gamma knife radiosurgery (GKRS); radionecrosis (RN); recurrence.