Magnetic Resonance Imaging Mapping of Brain Tumor Burden: Clinical Implications for Neurosurgical Management: Case Report. Issue 4 (16th September 2021)

• Record Type: Journal Article
• Authors: Connelly, Jennifer M; Prah, Melissa A; Santos-Pinheiro, Fernando; Mueller, Wade; Cochran, Elizabeth; Schmainda, Kathleen M
• Is Part Of: Neurosurgery open. Volume 2:Issue 4(2021)
• Publication Date: 2021-09-16
• Subjects: Brain tumor -- Neurosurgery -- Fractional tumor burden (FTB) -- MRI -- Pseudoprogression -- Relative cerebral blood volume (rCBV) -- Case report; Nervous system -- Surgery -- Periodicals; 617.48
• DOI: 10.1093/neuopn/okab029
• Languages: English
• ISSNs: 2633-0873

Abstract

ABSTRACT: BACKGROUND AND IMPORTANCE: Distinction of brain tumor progression from treatment effect on postcontrast magnetic resonance imaging (MRI) is an ongoing challenge in the management of brain tumor patients. A newly emerging MRI biomarker called fractional tumor burden (FTB) has demonstrated the ability to spatially distinguish high-grade brain tumor from treatment effect with important implications for surgical management and pathological diagnosis. CLINICAL PRESENTATION: A 58-yr-old male with glioblastoma was treated with standard concurrent chemoradiotherapy (CRT) after initial resection. Throughout follow-up imaging, the distinction of tumor progression from treatment effect was of concern. The surgical report from a redo resection indicated recurrent glioblastoma, while the tissue sent for pathological diagnosis revealed no tumor. Presurgical FTB maps confirmed the spatial variation of tumor and treatment effect within the contrast-agent enhancing lesion. Unresected lesion, shown to be an active tumor on FTB, was the site of substantial tumor growth postresection. CONCLUSION: This case report introduces the idea that a newly developed MRI biomarker, FTB, can provide information of tremendous benefit for surgical management, pathological diagnosis as well as subsequent treatment management decisions in high-grade glioma.