23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note
23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note
复制标题
DOI：
10.1007/s00234-014-1468-2
复制
发表时间：
2015-03-01
期刊：
影响因子：
2.8
通讯作者：
Ong, Melissa M.
中科院分区：
文献类型：
--
作者：
Haneder, Stefan;Giordano, Frank A.;Ong, Melissa M.
我们报告了第一例复发性多形性胶质母细胞瘤（GBM）患者的术中放疗（IORT），该患者随访时采用了一种新型磁共振成像（MRI）方法- na -23-MRI，与标准对比增强的h -1 MRI和f -18 fet - pet进行了比较。女性，56岁，2012年7月确诊为GBM，行肿瘤切除、放化疗、3周期化疗。复发后，初次诊断6个月后，建议于2013年3月使用INTRABEAM系统（德国卡尔蔡司医疗器械公司）进行IORT，使用3厘米的涂抹器，表面剂量为20 Gy。术后早期进行对比增强和随访1个月的h -1 mri和f -18 fet - pet检查。此外，在3.0 t MR扫描仪（MAGNETOM TimTrio, Siemens Healthcare，德国）上进行irb批准的na -23 mri。2013年3月再次手术和IORT后，在中-后切除边缘仅可见微弱的对比增强，但周围明显水肿。2013年4月，在F-18-FET-PET上可见新的渐进式对比增强，水肿，Na-23含量，摄取增加，提示肿瘤复发。在Na-23-MRI中发现，在对比增强区域内钠含量增加，但也超过了该区域，与f -18 fet - pet中描述的钠摄入量增加非常相似。与疑似肿瘤组织增生的区域相比，两种检查中清晰描绘的水肿区显示Na-23含量较低。与f -18 fet - pet相比，na -23 mri在可疑区域提供了类似的信息，超过了传统的h -1 mri。尽管如此，Na-23-MRI仍然是一种研究性技术，值得进一步评估。
We report the first case of an intraoperative radiotherapy (IORT) in a patient with recurrent glioblastoma multiforme (GBM) who was followed up with a novel magnetic resonance imaging (MRI) method-Na-23-MRI-in comparison to a standard contrast-enhanced H-1-MRI and F-18-FET-PET.A 56-year-old female patient with diagnosed GBM in July 2012 underwent tumor resection, radiochemotherapy, and three cycles of chemotherapy. After a relapse, 6 months after the initial diagnosis, an IORT was recommended which was performed in March 2013 using the INTRABEAM system (Carl Zeiss Meditec AG, Germany) with a 3-cm applicator and a surface dose of 20 Gy. Early post-operative contrast-enhanced and 1-month follow-up H-1-MRI and a F-18-FET-PET were performed. In addition, an IRB-approved Na-23-MRI was performed on a 3.0-T MR scanner (MAGNETOM TimTrio, Siemens Healthcare, Germany).After re-surgery and IORT in March 2013, only a faint contrast enhancement but considerable surrounding edema was visible at the medio-posterior resection margins. In April 2013, new and progressive contrast enhancement, edema, Na-23 content, and increased uptake in the F-18-FET-PET were visible, indicating tumor recurrence. Increased sodium content within the area of contrast enhancement was found in the Na-23-MRI, but also exceeding this area, very similar to the increased uptake depicted in the F-18-FET-PET. The clearly delineable zone of edema in both examinations exhibits a lower Na-23 content compared to areas with suspected proliferating tumor tissue.Na-23-MRI provided similar information in the suspicious area compared to F-18-FET-PET, exceeding conventional H-1-MRI. Still, Na-23-MRI remains an investigational technique, which is worth to be further evaluated.