Radiologic and histologic consequences of radiosurgery for brain tumors

Ahmed Alomari, Philipp J. Rauch, Maria Orsaria, Frank J. Minja, Veronica L. Chiang, Alexander Vortmeyer

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Progressively enlarging encephalopathic changes are now well-documented effects of gamma knife radiosurgery (GKRS) occurring ~3-30 months after treatment of both benign and malignant brain lesions. These changes can be variably associated with inflammatory demyelination and necrosis and/or recurrent tumor. While radiographic differentiation between encephalopathic changes and recurrent tumor is of high clinical relevance, confident interpretation of post-radiosurgery imaging changes can be challenging or even impossible in some cases. Gadolinium-enhanced MRI of these lesions reveals variable amounts of enhancing and non-enhancing components within these lesions that have not been clearly correlated with structural-pathologic change. The goal of this study is to characterize the histopathological changes associated with enhancing versus non-enhancing regions of GKRS-treated lesions. MRI images of patients with progressive, etiologically ambiguous brain lesions following GKRS were reviewed prior to explorative neurosurgery. Chosen for this study were lesions in which distinct areas of enhancement and non-enhancement of at least 5 mm in size could be identified (n = 16). Distinctly enhancing and non-enhancing areas were separately biopsied and histologically evaluated. Only cases with uniform histological results are presented in this study. Enhancing and non-enhancing areas in post GKRS lesions represent separate pathological changes. Radiographically enhancing areas correlate either with recurrent tumor growth or inflammatory demyelinating changes. Lack of radiographic enhancement correlates with coagulative necrosis if the sample is taken from the center of the lesion, or with reactive astrocytosis if the sample is taken from the periphery. Separate biopsy of enhancing and non-enhancing regions of post-GKRS encephalopathy was able to confirm that the pathologies in these areas are distinct. These findings allow for better-informed correlation of histological and radiological changes and a better understanding of post-treatment tissue pathology.

Original languageEnglish (US)
Pages (from-to)33-42
Number of pages10
JournalJournal of Neuro-Oncology
Volume117
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Radiosurgery
Brain Neoplasms
Necrosis
Pathology
Neoplasms
Gliosis
Gadolinium
Brain
Neurosurgery
Brain Diseases
Demyelinating Diseases
Biopsy
Therapeutics
Growth

Keywords

  • Coagulative necrosis
  • Gamma knife radiosurgery
  • Inflammatory demyelination
  • Radiation-induced encephalopathy

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Radiologic and histologic consequences of radiosurgery for brain tumors. / Alomari, Ahmed; Rauch, Philipp J.; Orsaria, Maria; Minja, Frank J.; Chiang, Veronica L.; Vortmeyer, Alexander.

In: Journal of Neuro-Oncology, Vol. 117, No. 1, 01.01.2014, p. 33-42.

Research output: Contribution to journalArticle

Alomari, Ahmed ; Rauch, Philipp J. ; Orsaria, Maria ; Minja, Frank J. ; Chiang, Veronica L. ; Vortmeyer, Alexander. / Radiologic and histologic consequences of radiosurgery for brain tumors. In: Journal of Neuro-Oncology. 2014 ; Vol. 117, No. 1. pp. 33-42.
@article{ee3a75fce5e84253a89a0f68b57ba143,
title = "Radiologic and histologic consequences of radiosurgery for brain tumors",
abstract = "Progressively enlarging encephalopathic changes are now well-documented effects of gamma knife radiosurgery (GKRS) occurring ~3-30 months after treatment of both benign and malignant brain lesions. These changes can be variably associated with inflammatory demyelination and necrosis and/or recurrent tumor. While radiographic differentiation between encephalopathic changes and recurrent tumor is of high clinical relevance, confident interpretation of post-radiosurgery imaging changes can be challenging or even impossible in some cases. Gadolinium-enhanced MRI of these lesions reveals variable amounts of enhancing and non-enhancing components within these lesions that have not been clearly correlated with structural-pathologic change. The goal of this study is to characterize the histopathological changes associated with enhancing versus non-enhancing regions of GKRS-treated lesions. MRI images of patients with progressive, etiologically ambiguous brain lesions following GKRS were reviewed prior to explorative neurosurgery. Chosen for this study were lesions in which distinct areas of enhancement and non-enhancement of at least 5 mm in size could be identified (n = 16). Distinctly enhancing and non-enhancing areas were separately biopsied and histologically evaluated. Only cases with uniform histological results are presented in this study. Enhancing and non-enhancing areas in post GKRS lesions represent separate pathological changes. Radiographically enhancing areas correlate either with recurrent tumor growth or inflammatory demyelinating changes. Lack of radiographic enhancement correlates with coagulative necrosis if the sample is taken from the center of the lesion, or with reactive astrocytosis if the sample is taken from the periphery. Separate biopsy of enhancing and non-enhancing regions of post-GKRS encephalopathy was able to confirm that the pathologies in these areas are distinct. These findings allow for better-informed correlation of histological and radiological changes and a better understanding of post-treatment tissue pathology.",
keywords = "Coagulative necrosis, Gamma knife radiosurgery, Inflammatory demyelination, Radiation-induced encephalopathy",
author = "Ahmed Alomari and Rauch, {Philipp J.} and Maria Orsaria and Minja, {Frank J.} and Chiang, {Veronica L.} and Alexander Vortmeyer",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s11060-014-1359-8",
language = "English (US)",
volume = "117",
pages = "33--42",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Kluwer Academic Publishers",
number = "1",

}

TY - JOUR

T1 - Radiologic and histologic consequences of radiosurgery for brain tumors

AU - Alomari, Ahmed

AU - Rauch, Philipp J.

AU - Orsaria, Maria

AU - Minja, Frank J.

AU - Chiang, Veronica L.

AU - Vortmeyer, Alexander

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Progressively enlarging encephalopathic changes are now well-documented effects of gamma knife radiosurgery (GKRS) occurring ~3-30 months after treatment of both benign and malignant brain lesions. These changes can be variably associated with inflammatory demyelination and necrosis and/or recurrent tumor. While radiographic differentiation between encephalopathic changes and recurrent tumor is of high clinical relevance, confident interpretation of post-radiosurgery imaging changes can be challenging or even impossible in some cases. Gadolinium-enhanced MRI of these lesions reveals variable amounts of enhancing and non-enhancing components within these lesions that have not been clearly correlated with structural-pathologic change. The goal of this study is to characterize the histopathological changes associated with enhancing versus non-enhancing regions of GKRS-treated lesions. MRI images of patients with progressive, etiologically ambiguous brain lesions following GKRS were reviewed prior to explorative neurosurgery. Chosen for this study were lesions in which distinct areas of enhancement and non-enhancement of at least 5 mm in size could be identified (n = 16). Distinctly enhancing and non-enhancing areas were separately biopsied and histologically evaluated. Only cases with uniform histological results are presented in this study. Enhancing and non-enhancing areas in post GKRS lesions represent separate pathological changes. Radiographically enhancing areas correlate either with recurrent tumor growth or inflammatory demyelinating changes. Lack of radiographic enhancement correlates with coagulative necrosis if the sample is taken from the center of the lesion, or with reactive astrocytosis if the sample is taken from the periphery. Separate biopsy of enhancing and non-enhancing regions of post-GKRS encephalopathy was able to confirm that the pathologies in these areas are distinct. These findings allow for better-informed correlation of histological and radiological changes and a better understanding of post-treatment tissue pathology.

AB - Progressively enlarging encephalopathic changes are now well-documented effects of gamma knife radiosurgery (GKRS) occurring ~3-30 months after treatment of both benign and malignant brain lesions. These changes can be variably associated with inflammatory demyelination and necrosis and/or recurrent tumor. While radiographic differentiation between encephalopathic changes and recurrent tumor is of high clinical relevance, confident interpretation of post-radiosurgery imaging changes can be challenging or even impossible in some cases. Gadolinium-enhanced MRI of these lesions reveals variable amounts of enhancing and non-enhancing components within these lesions that have not been clearly correlated with structural-pathologic change. The goal of this study is to characterize the histopathological changes associated with enhancing versus non-enhancing regions of GKRS-treated lesions. MRI images of patients with progressive, etiologically ambiguous brain lesions following GKRS were reviewed prior to explorative neurosurgery. Chosen for this study were lesions in which distinct areas of enhancement and non-enhancement of at least 5 mm in size could be identified (n = 16). Distinctly enhancing and non-enhancing areas were separately biopsied and histologically evaluated. Only cases with uniform histological results are presented in this study. Enhancing and non-enhancing areas in post GKRS lesions represent separate pathological changes. Radiographically enhancing areas correlate either with recurrent tumor growth or inflammatory demyelinating changes. Lack of radiographic enhancement correlates with coagulative necrosis if the sample is taken from the center of the lesion, or with reactive astrocytosis if the sample is taken from the periphery. Separate biopsy of enhancing and non-enhancing regions of post-GKRS encephalopathy was able to confirm that the pathologies in these areas are distinct. These findings allow for better-informed correlation of histological and radiological changes and a better understanding of post-treatment tissue pathology.

KW - Coagulative necrosis

KW - Gamma knife radiosurgery

KW - Inflammatory demyelination

KW - Radiation-induced encephalopathy

UR - http://www.scopus.com/inward/record.url?scp=84901606192&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901606192&partnerID=8YFLogxK

U2 - 10.1007/s11060-014-1359-8

DO - 10.1007/s11060-014-1359-8

M3 - Article

VL - 117

SP - 33

EP - 42

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

IS - 1

ER -