Dynamic imaging of intracranial lesions using fast spin‐echo imaging: Differentiation of brain tumors and treatment effects

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Abstract
The purpose of this study was to develop a technique for differentiating between recurrent brain tumors and treatment‐related changes, such as radiation necrosis, using dynamic MRI. Ninety‐five patients with intracranial mass lesions were evaluated using T1‐weighted fast spin‐echo (FSE) MRI at 1.5 T. Pathologies included treatment‐related changes (n = 32), primary tumors (n = 41), metastatic tumors (n = 5), meningiomas (n = 4), and mixed primary/treatment related changes (n = 13). Signal enhancement‐time curves were analyzed by fitting to a sigmoidal‐exponential function. Maximal enhancement rates were calculated as the first derivative of the fitted curve. Based on the maximal enhancement rates, treatment‐related changes could be differentiated from primary tumors, metastatic tumors, and meningiomas at the P < .05 confidence level. Lesions of mixed tumor and treatment‐related change had intermediate values. Dynamic MRI can be used to differentiate treatment‐related changes from primary tumors in previously treated patient populations based on maximal enhancement rates. Individual case studies demonstrate the clinical significance of these findings.