mri results

[juliearigarcia]

does anyone know what all that means in my dad's last mri scan

[rosebud39]

My partner has been diagnosed with post radiation necrosis..He had a grade 3 astrocytoma removed from right temporal lobe in 2003..He then had intensive radiothethrapy to be absolutely sure it was eradicated..its a very catch 22 situation for doctors to decide how much to give to save a life but also to continue a quality of life..after the surg/treatment he was given valpro+tegrtol to control seizures which cause fatigue+tiredness etc..12 months ago his memory and cognitive skills were noticeably deteriorating even though he was unaware..but it soon became apparent when he lost his job and 5 new jobs within a few months..After 12 months of tests including a neuro psychological assessment it seems the degeneration is due to brain necrosis not from tumour but from radiation 8 years ago and apparently is progressive as there is no treatment for it and the cells can't recover..but it was also said that its unknown whether anyone has survived this long from the tumour he had..so it is basically unknown territory and a miracle he is still alive..if any one knows about post radiation effect + if there is any hope I would love to hear from you..he was 35 when diagnosed and has been in remission since.

[rumpled]

Some people get the side effects, which are not common, and some people do not - and from what I have read - it is not easy to predict who will get the side effects.
Found on a website:
"When brain tumors are treated with radiation therapy, there is always a risk of radiation-induced necrosis of healthy brain tissue. Insidious and potentially fatal, radiation necrosis of the brain may develop months or even years after irradiation.

This poorly understood side effect can occur even when the most stringent measures are taken to avoid exposing healthy tissue to harmful levels of radiation. In most cases, radiation necrosis of the brain occurs at random, without known genetic or other predisposing risk factors. The only treatment options typically available for radiation necrosis of the brain are surgery to remove dead tissue and use of the steroid dexamethasone to provide limited symptom control. But clinicians have not found a way to stop the progression of necrosis, despite having tested a range of therapies including anticoagulants, hyperbaric oxygen, and high-dose anti-inflammatory regimens. "

The docs try to calibrate the radiation to limit damage - after all, they want to only kill the tumor, not the patient... so this is not a usual thing.

Have you consulted the doctors since the imaging to find out what can be done now? I agree, it is a very difficult situation.

[juliearigarcia]

should he have received so much radiation if it was a benign tumor  after the removal of the tumor in 2007.  He started having signs that something was wrong last year, so he was admitted to the hospital and we were told they could not do anything.  We decided to go for a second opinion at md anderson (m,arch 2009) and there he was taking advastin he seemed to be doing better but then the dr decided to stop that treatment in dec and continue with the tremador only.  In jan he had a heartattack and had two stents placed.  He continued with the temador but he never liked taking the med would tell us it made him feel worse.  I wonder if it was just the necrosis making him feel the way he did and not the cancer med. In May 2011 he went for an mri and it showed progression, he was in and out of the hospital for about 4 weeks.  They did that mri before being released from the hospital.    Right now he is bed and cannot move his right side and unable to speak.  He communicates with a maybe one word sentence or signs. He will continue treatment with a local oncologist that will be communicating with the drs in houston.   I  keep questioning myself if the radiation was worth it.  This is so hard and I just have so many questions.  Is there any possiblity he could of had a stroke, it seemed from the time of his last seizure although it was very mild he worsened.  Can some of the damage done by necrosis be reversed.  Thank you,

[rumpled]

I am only a layman.

My layman's interpretation of this report is that your father has had a lot of radiation. The radiation has had a lot of side effects now - and they are showing up on the MRI.

He has some necrosis - dead tissue. There is some calcification - hardening. He has some edema. The white matter changes can often be attributed to stroke but here they are saying it is radiation. He has no evidence of stroke.

They don't see that the cancer is back but the damage from the radiation to remove the cancer is evident...

There is also an expert forum where you can ask the question as well in case I did not help. I am sorry about your dad. I also lost my dad to brain cancer.

[juliearigarcia]

FULL RESULT:
Examination:  MRI Brain with and without Contrast, 06/20/2011  
  
Comparison:  MRI brain dated 05/20/2011 and 04/21/2011.
  
Clinical History:  A 59-year-old man with history of left frontal lobe grade 2 oligodendroglioma, status post total resection in 05/2007. The patient underwent radiation therapy in 2007 with subsequent recurrence. The patient has been undergoing chemotherapy with Avastin, which was discontinued in 12/2010. The patient has also undergone treatment with Temodar. Now with worsening dysphagia and speech impediment.
  
Findings:  Multiplanar and multisequential MR images of the brain are done with and without contrast.
  
Cystic changes are again noted within the left frontal resection cavity with stable surrounding irregular area of intense enhancement extending into the left frontal lobe, left frontotemporal operculum, and left basal ganglia. The area of enhancement measures 6.6 cm tall x 3.9 cm wide x 4 cm AP. The pattern of enhancement has a swiss cheese appearance favoring radiation-induced necrosis.
  
There are multiple small foci of enhancement in the left frontal lobe and periventricular white matter, not significantly changed since prior examination  Two new enhancing subcentimeter foci are seen in the right frontal lobe (series 9, image 20) and left inferior cerebellum (series 10, image 21 and series 11, image 10).
  
There has been interval worsening of FLAIR/T2 signal abnormality surrounding the resection cavity with further extension into the frontal lobe posteriorly. There is stable indentation of the left frontal horn. Minimal localized mass effect is seen on the ventricles without significant midline shift. Right periventricular and subcortical white matter T2/FLAIR signal abnormality has not significantly changed. This likely represents edema and/or postradiation change.
  
There is no evidence of acute or subacute infarction. The major intracranial flow voids are intact. There is no evidence of hydrocephalus. Bilateral orbits and paranasal sinuses are intact.
  
  Thickening of the right nasal turbinates is again noted. No obvious calvarial lesions are identified. There is evidence of left frontal craniotomy.
  
  
  
  
IMPRESSION:
  
1. Stable inhomogeneous intense enhancement around the left frontal lobe resection cavity extending deep into the basal ganglia region , in a swiss cheese pattern favoring radition induced necrosis .
2. Areas of calcification and/or hemosiderin deposition are again seen along the resection cavity.
  
3. Interval mild worsening of FLAIR/T2 signal abnormality involving the left frontoparietal lobes. There is minimal mass effect on the ventricles without significant midline shift. This signal abnormality likely represents edema and/or postradiation change.  
  
4. Two new subcentimeter enhancing foci in the right frontal lobe and left inferior cerebellum with other similar foci seen in the left frontal lobe and periventricular white matter. These likely represent postradiation changes.
  
5. No evidence of acute or subacute infarction.
  
I interpreted this examination before dictation and agree with this written report.