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Improvement of cerebral hypometabolism after resection of radiation-induced necrotic lesion in a patient with cerebral arteriovenous malformation.

Harada Y, Hirata K, Nakayama N, Yamaguchi S, Yoshida M, Onodera S, Manabe O, Shiga T, Terae S, Shirato H, Tamaki N - Acta Radiol Open (2015)

Bottom Line: Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms.While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms.This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

ABSTRACT
A 55-year-old woman underwent radiosurgery for a left cerebral hemisphere arteriovenous malformation (AVM) and developed radiation-induced necrosis causing a massive edema in the surrounding brain tissues. Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms. The radiation-induced necrotic lesion was surgically removed 4 years after radiosurgery. While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms. This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy.

No MeSH data available.


Related in: MedlinePlus

Radiologic studies 4 years after the SRS. (a) A non-contrasted axial CT showed partially calcified AVM in the left frontal lobe white matter (arrows). The small hyperattenuating lesion was compatible with microbleeding (arrowhead). (b, c) An axial T2W MRI showed a necrotic mass (arrow) and surrounding massive edematous lesion (arrowheads) in the subcortical white matter, from the left supra and middle frontal gyri to the middle temporal gyrus. (d) FDG PET demonstrated not only a defect of tracer accumulation in the necrotic core but also severe hypometabolism in the surrounding brain tissues (arrowheads). The lesion-to-contralateral ratio of standardized uptake value was 0.78 in the left precentral gyrus. (e) Three weeks after necrotomy, a T2W MRI showed high signal intensity (arrowhead) representing the resected site with brain edema significantly reduced. (f) A postoperative FDG PET examination showed remarkable recovery of metabolic activity in the left cortex (arrowheads). The lesion-to-contralateral ratio increased to 0.90 in the left precentral gyrus.
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fig3-2058460115584112: Radiologic studies 4 years after the SRS. (a) A non-contrasted axial CT showed partially calcified AVM in the left frontal lobe white matter (arrows). The small hyperattenuating lesion was compatible with microbleeding (arrowhead). (b, c) An axial T2W MRI showed a necrotic mass (arrow) and surrounding massive edematous lesion (arrowheads) in the subcortical white matter, from the left supra and middle frontal gyri to the middle temporal gyrus. (d) FDG PET demonstrated not only a defect of tracer accumulation in the necrotic core but also severe hypometabolism in the surrounding brain tissues (arrowheads). The lesion-to-contralateral ratio of standardized uptake value was 0.78 in the left precentral gyrus. (e) Three weeks after necrotomy, a T2W MRI showed high signal intensity (arrowhead) representing the resected site with brain edema significantly reduced. (f) A postoperative FDG PET examination showed remarkable recovery of metabolic activity in the left cortex (arrowheads). The lesion-to-contralateral ratio increased to 0.90 in the left precentral gyrus.

Mentions: The follow-up MRIs demonstrated gradual obliteration of the AVM. Two years after the SRS, she developed recurrent headaches, and right-sided lower limb paresthesia. Contrast-enhanced T1-weighted (T1W) MRI showed an enhanced lesion at the previous AVM site, indicating brain necrosis (Fig. 2a). T2-weighted (T2W) MRI showed a massive brain edema around the necrotic lesion (Fig. 2b). Despite steroids therapy and hyperbaric oxygen therapy, she suffered from repeated focal seizures and developed progressive hemiparesis. During the next 2 years, she was admitted to our hospital six times for symptoms of raised intracranial pressure, and treated with steroids. Four years after SRS, she was admitted to our hospital because of tonic seizure. Computed tomography (CT) scanning revealed microbleeding foci in the necrotic tissue (Fig. 3a). T2W MRI showed a necrotic mass and surrounding massive edema in the left hemisphere (Fig. 3b and c). On DSA, neither residual AVM nor early draining vein was observed, which confirmed complete obliteration (2).Fig. 2.


Improvement of cerebral hypometabolism after resection of radiation-induced necrotic lesion in a patient with cerebral arteriovenous malformation.

Harada Y, Hirata K, Nakayama N, Yamaguchi S, Yoshida M, Onodera S, Manabe O, Shiga T, Terae S, Shirato H, Tamaki N - Acta Radiol Open (2015)

Radiologic studies 4 years after the SRS. (a) A non-contrasted axial CT showed partially calcified AVM in the left frontal lobe white matter (arrows). The small hyperattenuating lesion was compatible with microbleeding (arrowhead). (b, c) An axial T2W MRI showed a necrotic mass (arrow) and surrounding massive edematous lesion (arrowheads) in the subcortical white matter, from the left supra and middle frontal gyri to the middle temporal gyrus. (d) FDG PET demonstrated not only a defect of tracer accumulation in the necrotic core but also severe hypometabolism in the surrounding brain tissues (arrowheads). The lesion-to-contralateral ratio of standardized uptake value was 0.78 in the left precentral gyrus. (e) Three weeks after necrotomy, a T2W MRI showed high signal intensity (arrowhead) representing the resected site with brain edema significantly reduced. (f) A postoperative FDG PET examination showed remarkable recovery of metabolic activity in the left cortex (arrowheads). The lesion-to-contralateral ratio increased to 0.90 in the left precentral gyrus.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4548730&req=5

fig3-2058460115584112: Radiologic studies 4 years after the SRS. (a) A non-contrasted axial CT showed partially calcified AVM in the left frontal lobe white matter (arrows). The small hyperattenuating lesion was compatible with microbleeding (arrowhead). (b, c) An axial T2W MRI showed a necrotic mass (arrow) and surrounding massive edematous lesion (arrowheads) in the subcortical white matter, from the left supra and middle frontal gyri to the middle temporal gyrus. (d) FDG PET demonstrated not only a defect of tracer accumulation in the necrotic core but also severe hypometabolism in the surrounding brain tissues (arrowheads). The lesion-to-contralateral ratio of standardized uptake value was 0.78 in the left precentral gyrus. (e) Three weeks after necrotomy, a T2W MRI showed high signal intensity (arrowhead) representing the resected site with brain edema significantly reduced. (f) A postoperative FDG PET examination showed remarkable recovery of metabolic activity in the left cortex (arrowheads). The lesion-to-contralateral ratio increased to 0.90 in the left precentral gyrus.
Mentions: The follow-up MRIs demonstrated gradual obliteration of the AVM. Two years after the SRS, she developed recurrent headaches, and right-sided lower limb paresthesia. Contrast-enhanced T1-weighted (T1W) MRI showed an enhanced lesion at the previous AVM site, indicating brain necrosis (Fig. 2a). T2-weighted (T2W) MRI showed a massive brain edema around the necrotic lesion (Fig. 2b). Despite steroids therapy and hyperbaric oxygen therapy, she suffered from repeated focal seizures and developed progressive hemiparesis. During the next 2 years, she was admitted to our hospital six times for symptoms of raised intracranial pressure, and treated with steroids. Four years after SRS, she was admitted to our hospital because of tonic seizure. Computed tomography (CT) scanning revealed microbleeding foci in the necrotic tissue (Fig. 3a). T2W MRI showed a necrotic mass and surrounding massive edema in the left hemisphere (Fig. 3b and c). On DSA, neither residual AVM nor early draining vein was observed, which confirmed complete obliteration (2).Fig. 2.

Bottom Line: Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms.While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms.This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

ABSTRACT
A 55-year-old woman underwent radiosurgery for a left cerebral hemisphere arteriovenous malformation (AVM) and developed radiation-induced necrosis causing a massive edema in the surrounding brain tissues. Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms. The radiation-induced necrotic lesion was surgically removed 4 years after radiosurgery. While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms. This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy.

No MeSH data available.


Related in: MedlinePlus