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MR Imaging Response of Brain Metastases after Gamma Knife Stereotactic Radiosurgery¹

¹ From the Departments of Radiology, Division of Neuroradiology (A.M.P., C.C.M., E.J.E.), Psychiatry (C.C.M.), Radiation Oncology (J.C.F., D.K.), and Neurological Surgery (J.C.F., D.K.), University of Pittsburgh Medical Center, Rm PUH D-132, 200 Lothrop St, Pittsburgh, PA 15213-2582. Received March 20, 1998; revision requested June 17; revision received August 7; accepted November 5. Address reprint requests to A.M.P.

PURPOSE: To characterize the magnetic resonance (MR) imaging response of brain metastases after gamma knife stereotactic radiosurgery and determine whether imaging features and tumor response rates correlate with local tumor control and survival.

MATERIALS AND METHODS: Serial MR examinations were performed in 48 patients (25 men, 23 women; mean age, 58 years) with 78 lesions. Pretreatment and follow-up enhancing lesion volumes and imaging features were assessed. Rates of response to stereotactic radiosurgery were calculated. Prognostic imaging features affecting local control and survival were analyzed.

RESULTS: Local tumor control was achieved in 66 (90%) of 73 metastases at 20 weeks after stereotactic radiosurgery; 61% maintained local control at 2 years. A homogeneous baseline enhancement pattern and initial good response rate (>50% lesion volume reduction) predicted local control. Five metastases demonstrated a transient volume increase after treatment. The median survival time after stereotactic radiosurgery was 53 weeks and correlated with systemic disease burden and primary tumor type.

CONCLUSION: Baseline homogeneous tumor enhancement and initial good response correlate with local control. Initial lesion growth does not preclude local control and may represent radiation-related change. Recognition of these serial MR imaging findings may guide image interpretation and influence treatment in patients with stereotactic radiosurgery–treated metastases.

Index terms: Brain, MR, 13.121411, 13.12143 • Brain neoplasms, secondary, 13.381, 13.3810, 13.3816, 13.38181, 13.382, 13.3820, 13.3826, 13.38281 • Stereotaxis, 13.1267

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