Improving detection of brain meatastases for stereotactic radiosurgery and its impact on clinical practice: a single institution experienceKeywords: brain metastasis, gamma knife, Imaging, radiosurgery, magnetic resonance imagingInteractive Manuscript
Ask Questions of this Manuscript:
What is the background behind your study?
Although clinical decisions regarding the use of stereotactic radiosurgery (SRS) are frequently based on the number of metastases identified, there is no consensus methodology for determining the number of metastatic lesions.
What is the purpose of your study?
This study presents a retrospective analysis of expected versus
identified number of metastases in patients treated with GammaKnife
using a uniform imaging technique.
Describe your patient group.
100 patients high-resolution imaging studies were evaluated.
Describe what you did.
A retrospective, IRB approved review of 100 consecutive newly diagnosed
patients treated with stereotactic radiosurgey for brain metastases
using GammaKnife (GK) Perfexion from October 2009 to May 2011 was
performed. Non small cell lung cancers comprised 40% of patients
followed by breast, renal cell and melanoma ; small cell cancers were
excluded.
Describe your main findings.
All GK all patients underwent rigid head fixation followed by 3-dimensional stereotactic magnetic resonance imaging (MRI) using double-dose gadolinium contrast with fast spoiled-gradient sequence (SPGR) performed using 2-mm thick axial cuts with no spacing.
Describe the main limitation of this study.
This was a retrospective review.
Describe your main conclusion.
For patients with the expectation of single metastases (50% of all patients), 25.5% were found to have one or more additional metastases. For patients with 2 – 3 expected metastasis, 48.6% had additional lesions, and among patients with more than 3 metastases expected, 93% had additional lesions at the time of GK imaging. Overall additional metastases were detected in 43% of cases.
Describe the importance of your findings and how they can be used by others.
The probability of finding additional metastases was highly correlated
with the number on the baseline exam (p< 0.0001 for 1 vs. 2-3 or 1
vs. >3 lesions).
Although clinical decisions regarding the use of stereotactic radiosurgery (SRS) are frequently based on the number of metastases identified, there is no consensus methodology for determining the number of metastatic lesions.
This study presents a retrospective analysis of expected versus
identified number of metastases in patients treated with GammaKnife
using a uniform imaging technique.
100 patients high-resolution imaging studies were evaluated.
A retrospective, IRB approved review of 100 consecutive newly diagnosed
patients treated with stereotactic radiosurgey for brain metastases
using GammaKnife (GK) Perfexion from October 2009 to May 2011 was
performed. Non small cell lung cancers comprised 40% of patients
followed by breast, renal cell and melanoma ; small cell cancers were
excluded.
All GK all patients underwent rigid head fixation followed by 3-dimensional stereotactic magnetic resonance imaging (MRI) using double-dose gadolinium contrast with fast spoiled-gradient sequence (SPGR) performed using 2-mm thick axial cuts with no spacing.
This was a retrospective review.
For patients with the expectation of single metastases (50% of all patients), 25.5% were found to have one or more additional metastases. For patients with 2 – 3 expected metastasis, 48.6% had additional lesions, and among patients with more than 3 metastases expected, 93% had additional lesions at the time of GK imaging. Overall additional metastases were detected in 43% of cases.
The probability of finding additional metastases was highly correlated
with the number on the baseline exam (p< 0.0001 for 1 vs. 2-3 or 1
vs. >3 lesions).
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