Restriction-Spectrum Imaging of Bevacizumab-Related Necrosis in a Patient with GBM

Nikdokht Farid; Daniela B Almeida-Freitas; Nathan S White; Carrie R McDonald; Karra A Muller; Scott R VandenBerg; Santosh Kesari; Anders M Dale

doi:10.3389/fonc.2013.00258

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Restriction-Spectrum Imaging of Bevacizumab-Related Necrosis in a Patient with GBM

Journal article

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Restriction-Spectrum Imaging of Bevacizumab-Related Necrosis in a Patient with GBM

Nikdokht Farid, Daniela B Almeida-Freitas, Nathan S White, Carrie R McDonald, Karra A Muller, Scott R VandenBerg, Santosh Kesari and Anders M Dale

Frontiers in oncology, Vol.3, pp.258-258

2013

DOI: 10.3389/fonc.2013.00258

PMCID: PMC3786386

PMID: 24137566

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Abstract

Importance : With the increasing use of antiangiogenic agents in the treatment of high-grade gliomas, we are becoming increasingly aware of distinctive imaging findings seen in a subset of patients treated with these agents. Of particular interest is the development of regions of marked and persistent restricted diffusion. We describe a case with histopathologic validation, confirming that this region of restricted diffusion represents necrosis and not viable tumor. Observations : We present a case report of a 52-year-old man with GBM treated with temozolomide, radiation, and concurrent bevacizumab following gross total resection. The patient underwent sequential MRI’s which included restriction-spectrum imaging (RSI), an advanced diffusion-weighted imaging (DWI) technique, and MR perfusion. Following surgery, the patient developed an area of restricted diffusion on RSI which became larger and more confluent over the next several months. Marked signal intensity on RSI and very low cerebral blood volume (CBV) on MR perfusion led us to favor bevacizumab-related necrosis over recurrent tumor. Subsequent histopathologic evaluation confirmed coagulative necrosis. Conclusion and Relevance : Our report increases the number of pathologically proven cases of bevacizumab-related necrosis in the literature from three to four. Furthermore, our case demonstrates this phenomenon on RSI, which has been shown to have good sensitivity to restricted diffusion.

bevacizumab

glioblastoma multiforme

Oncology

diffusion-weighted imaging

necrosis

restriction-spectrum imaging

Details

Title: Subtitle: Restriction-Spectrum Imaging of Bevacizumab-Related Necrosis in a Patient with GBM
Creators: Nikdokht Farid - Department of Radiology, University of California San Diego
Daniela B Almeida-Freitas - Department of Radiology, University of California San Diego
Nathan S White - Department of Radiology, University of California San Diego
Carrie R McDonald - Multimodal Imaging Laboratory, University of California San Diego
Karra A Muller - Department of Pathology, University of California San Diego
Scott R VandenBerg - Department of Pathology, University of California San Diego
Santosh Kesari - Department of Neurosciences, University of California San Diego
Anders M Dale - Department of Radiology, University of California San Diego
Resource Type: Journal article
Publication Details: Frontiers in oncology, Vol.3, pp.258-258
DOI: 10.3389/fonc.2013.00258
PMID: 24137566
PMCID: PMC3786386
NLM abbreviation: Front Oncol
ISSN: 2234-943X
eISSN: 2234-943X
Publisher: Frontiers Media S.A
Language: English
Date published: 2013
Academic Unit: Pathology
Record Identifier: 9984047623902771

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