Differentiation of Recurrent Glioblastoma Multiforme From Radiation Necrosis After External Beam Radiation Therapy With Dynamic Susceptibility-Weighted Contrast-Enhanced Perfusion MR Imaging

Radiology. 2009 Nov;253(2):486-96. doi: 10.1148/radiol.2532090007. Epub 2009 Sep 29.


Purpose: To investigate whether cerebral blood volume (CBV), peak height (PH), and percentage of signal intensity recovery (PSR) measurements derived from the results of T2-weighted dynamic susceptibility-weighted contrast material-enhanced (DSC) magnetic resonance (MR) imaging performed after external beam radiation therapy (EBRT) can be used to distinguish recurrent glioblastoma multiforme (GBM) from radiation necrosis.

Materials and methods: Fifty-seven patients were enrolled in this HIPAA-compliant institutional review board-approved retrospective study after they received a diagnosis of GBM, underwent EBRT, and were examined with DSC MR imaging, which revealed progressive contrast enhancement within the radiation field. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up. Regions of interest were retrospectively drawn around the entire contrast-enhanced region. This created T2-weighted signal intensity-time curves that produced three cerebral hemodynamic MR imaging measurements: CBV, PH, and PSR. Welch t tests were used to compare measurements between groups.

Results: Mean, maximum, and minimum relative PH and relative CBV were significantly higher (P < .01) in patients with recurrent GBM than in patients with radiation necrosis. Mean, maximum, and minimum relative PSR values were significantly lower (P < .05) in patients with recurrent GBM than in patients with radiation necrosis.

Conclusion: These findings suggest that DSC perfusion MR imaging may be used to differentiate recurrent GBM from EBRT-induced radiation necrosis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Blood Volume
  • Brain / radiation effects*
  • Brain Neoplasms / diagnosis*
  • Brain Neoplasms / radiotherapy*
  • Cerebrovascular Circulation
  • Contrast Media*
  • Diagnosis, Differential
  • Female
  • Glioblastoma / diagnosis*
  • Glioblastoma / radiotherapy*
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Necrosis
  • Neoplasm Recurrence, Local / diagnosis*
  • Radiation Injuries / diagnosis*
  • Radiotherapy Dosage
  • Sensitivity and Specificity


  • Contrast Media