Różnicowanie popromiennej martwicy i wznowy złośliwego guza mózgu u pacjentów leczonych przy pomocy brachyterapii Ir 192 metodą HDR w oparciu o analizę spektroskopową widma metabolitów z użyciem H1-MRS

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Background: Computerized tomography (CT) with contrast infusion and Magnetic Resonance Imaging (MRI) do not differentiate radionecrosis and malignant tumor recurrence. Proton Magnetic Resonance Spectroscopy seems to be a new radiological method that could solve this problem. The aim of the study was to evaluate the usability of H1-MRS in patients after brachytherapy. Material/Methods: Sixty patients were treated by Ir 192 HDR brachytherapy because of malignant brain tumors (gliomas and brain metastases). Prospectively, 4 months after brachytherapy, 24 patients underwent MRI and H1-MRS examinations. All patients qualified for the prospective study were in good general condition before and after the brachytherapy (Karnofsky Performance Score (KPS) > 60%). Results: Combined assessment of MRI and H1-MRS gave us the possibility to differentiate the observed pathological changes. In 18 cases (75%) there was a decrease in tumor volume. The tumor infiltration area was larger than the necrotic area in 5 cases. An isolated recurrence mass was observed in only one case. Neurosurgical brain decompression with pathological mass resection was needed in 6 patients with increased intracranial pressure and enhanced neurological deficits. Histopathological examination confirmed the diagnosis revealed in the H1-MRS examination in each case. Conclusions: Proton Magnetic Resonance Spectroscopy is helpful in evaluating the influence of radiation on the tumor and the surrounding brain tissue. Moreover, it solves the problem of differentiating between radionecrosis and tumor recurrence.