Brain mets or scar tissue?

[Ann]

Has anyone with previous brain mets treated with sterotactic surgery had a doctor say he is not sure if it is a reoccurance or brain met? It so which one was it for you? The doctor recommends we have another MRI in 8 weeks and look for any changes. What a rollercoaster.

[karen w]

Hi Ann,

A person I know had lung cancer that spread to the brain. She was treated with the Gamma Knife and a few years later, she started have problems again. When they got the results from the MRI, the doctor didn't know if the cancer had returned, or if it was scar tissue. When they went in to biopsy it, they found out it was scar tissue. Yours could very well be scar tissue.

I sure hope this helps.

Karen

[Lisa]

Hang on tight...a roller coaster indeed! So far (1 year), my brain mets have proven clear, but you just never know. I assume your radiation oncologist took a look at the films. Were the "spots" on the same places as pre-radiation mets?

Brain mets CAN reoccur and 8 weeks is a long time to wait. Then again, scar tissue it could be. (I sound like Star Wars.) Have a 2nd person look at the films, then take a deep breath and try not to worry.

IF they are mets, you'll continue the fight.

Love and light,

Lisa

[*_Annemarie_*]

Hi,
So far 2 radiologist oncologist looked at the scans and think it is scar tissue and the neurosurgeon thinks it is 50/50. Both doctors did agree that waiting 6-8 weeks will tell them more. It is in close proximity to where I was treated last October.

[pattyz]

Anne,
here is something you may want to discuss with docs:

Performed together, MRI and MRS (magnetic resonance spectroscopy) produce an image of the brain that shows both morphology and tissue metabolism. Certain metabolites are present in greater or lesser quantities in tumors, compared to normal brain tissue. Choline is a cell-member marker that is found in increased quantities in malignant tumors.

MRS Applications in Oncology
By Pia C. Sundgren MD, PhD, Suresh K. Mukherji MD
Lately, MRS has been shown to be a helpful tool in evaluation of a new contrast-enhancing lesion at the site of a previously identified and treated primary intracranial neoplasm, differentiating recurrent tumor from radiation injury.

Radiation injury versus recurrent brain tumor . Contrast-enhancing lesions that arise on routine brain MR imaging at the site of a previously identified and treated primary intracranial neoplasm present a significant diagnostic dilemma. These lesions are in regions that have been subjected to radiation, with or without chemotherapy, and in some instances surgical resection. Many do not have specific imaging characteristics that will enable the neuroradiologist to discriminate tumor recurrence from the inflammatory or necrotic changes that can result from treatment with radiation. 28 Both recurrent tumors and radiation injury typically demonstrate enhancement with gadolinium. Specific spectroscopic changes that occur with radiation-induced necrosis have been reported and include slight depression of NAA and variable changes in choline. 29-32 A recent study reported a 93% success rate in differentiating recurrent tumor from radiation injury with significantly increased Cho/NAA and Cho/Cr ratios (P < 0.001) in areas of recurrent tumor compared to areas of radiation injury and compared to normal adjacent brain tissue. 33 These results also are supported by previous work utilizing SVS, where the authors claim that a Cho/Cr ratio over 1.79 or lipid-lactate/Cho ratio less than 0.75 has a sevenfold increased odds of indicating tumor compared to pure necrosis.

[*_Annemarie_*]

My neurosurgeon mentioned both tests but said sometimes even with both test it is inconclusive so they just keep monitoring the pts. with brain MRI's. He currently has a lung ca pt. with mets to the brain and she had both scans which did not show definate new mets so she is being monitored. The area has increased but it may be due to RT.