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Figure 1: T2-W axial images (a), T1-W axial images with intravenous contrast administration (b), demonstrated an extensive edematous lesion with
mass effect and heterogeneous enhancement (arrows), characteristic of both tumor recurrence and radiation necrosis. The diffusion weighted imaging
³
(DWI) demonstrated decreased values of the apparent diffusion coefficient (ADC) maps (c) (1.2-1.8x10¯ mm²) consisted with malignant tumor infiltration.
However, the fractional anisotropy (FA) (d) maps showed increased white matter tracts destruction (low FA) and the perfusion maps (CBV) (e) depicted
very low perfusion, both consisted with radiation-induced necrosis. SPECT (f) revealed increased metabolic activity (arrowheads) consisted with tumor
recurrence
total radiation dose of 5,500 to 6,000 rads over 6 (grade IV). She underwent standard radiotherapy
weeks period, and with concomitant temozolomide (6,000 rads) with concomitant temozolomide therapy,
chemotherapy. [3] Further chemotherapy with followed by 1 year of 5 days per month temozolomide
temozolomide may be given for approximately 1 chemotherapy. Subsequently, she remained stable
year thereafter. In any step during post radiotherapy on no further therapy until 1 year later when she
follow-up, change of any imaging characteristic developed progressive right hemiparesis, expressive
requires differentiation between tumor progression, aphasia and seizures. At that time, an MRI was
requiring therapy change, and radiation-induced performed demonstrating, in the T2-W axial images
necrosis, requiring mostly symptomatic therapy. In [Figure 1a] and T1-W axial images with intravenous
[4]
the present case the above question was raised in a contrast administration [Figure 1b], a mass
young patient requiring a large number of diagnostic lesion consistent with either tumor recurrence or
tests to be performed, which produced conflicted radiation necrosis. Diffusion weighted imaging
results requiring partial tumor resection for the (DWI) [Figure 1c] showed restricted diffusion
correct diagnosis. consistentwith malignant tumor infiltration.
However, the fractional anisotropy (FA) [Figure
CASE REPORT 1d] maps and the perfusion maps (CBV) [Figure 1e]
were consistent with radiation-induced necrosis.
A 35 years old woman was diagnosed with a left-frontal Subsequently, a 99m Tc-Tetrofosmin single photon
astrocytoma, grade II, 5 years prior to admission to emission computed tomography (SPECT) was
our hospital, during which time it was partially performed [Figure 1f], which revealed increased
resected without further treatment. Two years prior to metabolic activity, indicative of tumor recurrence.
admission, she had a recurrence, and a new resection Magnetic resonance (MR) spectroscopy demonstrated
revealed progression to glioblastoma multiforme decreased N-acetylaspartate (NAA) and increased
162 Neuroimmunol Neuroinflammation | Volume 3 | July 8, 2016