The Surgical Bed After BCNU Polymer Wafer Placement for Recurrent Glioma: Serial Assessment on CT and MR Imaging
Dima A. Hammoud1,
Clifford J. Belden2,
Amy C. Ho3,
Gerald J. Dal Pan4,
Edward H. Herskovits5,
Dana C. Hilt6,
Henry Brem7 and
Martin G. Pomper1
1 Department of Radiology, Division of Neuroradiology, The Johns Hopkins
University School of Medicine, 600 N. Wolfe St., Baltimore, MD
21287-2182.
2 Department of Radiology, Brooke Army Medical Center, 3851 Roger Brooke Dr.,
Fort Sam Houston, TX 78234-3600.
3 Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston,
MA 02115.
4 United States Food and Drug Administration, 5600 Fishers Ln., Rockville, MD
20857.
5 Department of Radiology, Division of Neuroradiology, Hospital of the
University of Pennsylvania, 3400 Sruce St., Philadelphia, PA 19104.
6 Guilford Pharmaceuticals, 6611 Tributary St., Baltimore, MD 21224.
7 Department of Neurosurgery, The Johns Hopkins University School of Medicine,
Baltimore, MD 21287.
View larger version (140K):
[in a new window]
|
Fig. 1A. —Typical wafer appearance in 73-year-old man who underwent
resection of anaplastic astrocytoma with placement of N, N' 1,
3-Bis-(2-chloroethyl)-N-nitrosourea (BCNU) polymer wafer. Axial
T1-weighted MR image obtained 1 day after wafer placement shows that wafers
(arrows) are linear and of low signal intensity.
|
|
View larger version (148K):
[in a new window]
|
Fig. 1B. —Typical wafer appearance in 73-year-old man who underwent
resection of anaplastic astrocytoma with placement of N, N' 1,
3-Bis-(2-chloroethyl)-N-nitrosourea (BCNU) polymer wafer. Axial
unenhanced CT scan obtained 2 weeks after surgery shows radiodense wafers
(straight arrows) and gas in surgical bed (curved arrow).
Gas in surgical bed was gone by next scan that was obtained 6 weeks later (not
shown).
|
|
View larger version (140K):
[in a new window]
|
Fig. 2B. —Evolution of gas in surgical bed in 46-year-old man with
recurrent glioblastoma multiforme. Axial contrast-enhanced CT scan shows gas
in surgical bed (arrows) 3 weeks after surgery. Wafers are no longer
visible.
|
|
View larger version (109K):
[in a new window]
|
Fig. 3C. —Tumor recurrence near surgical bed in 31-year-old man with
recurrent glioblastoma multiforme. Axial contrast-enhanced T1-weighted MR
image obtained 16 months after B shows tumor recurrence in posterior
periphery of original tumor margin (arrowheads).
|
|
View larger version (133K):
[in a new window]
|
Fig. 4A. —42-year-old man with recurrent left parietal anaplastic
astrocytoma. Axial contrast-enhanced T1-weighted MR image shows minimal
enhancement surrounding surgical cavity (arrowheads).
|
|
View larger version (128K):
[in a new window]
|
Fig. 4B. —42-year-old man with recurrent left parietal anaplastic
astrocytoma. Axial T1-weighted MR images obtained 18 days after surgery show
polymer wafers (arrows, B) composed of
N,N'1,3-Bis-(2-chloroethyl)-N-nitrosourea (BCNU) before
(B) and after (C) contrast enhancement. Enhancing rim around
surgical cavity (straight arrows, C) near wafers (curved
arrows, C) conforms to original tumor shape.
|
|
View larger version (132K):
[in a new window]
|
Fig. 4C. —42-year-old man with recurrent left parietal anaplastic
astrocytoma. Axial T1-weighted MR images obtained 18 days after surgery show
polymer wafers (arrows, B) composed of
N,N'1,3-Bis-(2-chloroethyl)-N-nitrosourea (BCNU) before
(B) and after (C) contrast enhancement. Enhancing rim around
surgical cavity (straight arrows, C) near wafers (curved
arrows, C) conforms to original tumor shape.
|
|
View larger version (138K):
[in a new window]
|
Fig. 4D. —42-year-old man with recurrent left parietal anaplastic
astrocytoma. On axial contrast-enhanced T1-weighted MR image, wafers are not
seen, and surgical bed, where wafers were placed (solid arrow), is
stable 2 months after placement, suggesting that original enhancement pattern
was due to residual tumor rather than wafers. New enhancing mass is identified
along posterior aspect of surgical bed (open arrow), compatible with
tumor recurrence.
|
|
View larger version (140K):
[in a new window]
|
Fig. 2A. —Evolution of gas in surgical bed in 46-year-old man with
recurrent glioblastoma multiforme. Axial T1-weighted MR image shows
characteristic appearance of N,
N'1,3-Bis-(2-chloroethyl)-N-nitrosourea (BCNU) polymer wafers
(arrows) and no gas in surgical bed 1 day after surgery.
|
|
View larger version (131K):
[in a new window]
|
Fig. 2C. —Evolution of gas in surgical bed in 46-year-old man with
recurrent glioblastoma multiforme. Axial contrast-enhanced axial T1-weighted
MR image obtained 1 month after CT scan (B) reveals no gas but
recurrent tumor (arrows).
|
|
View larger version (129K):
[in a new window]
|
Fig. 3A. —Tumor recurrence near surgical bed in 31-year-old man with
recurrent glioblastoma multiforme. Axial contrast-enhanced T1-weighted MR
image before repeated surgery and placement of N,
N'1,3-Bis-(2-chloroethyl)-N-nitrosourea (BCNU) polymer wafer
shows tumor (arrows) in left frontal lobe.
|
|
View larger version (138K):
[in a new window]
|
Fig. 3B. —Tumor recurrence near surgical bed in 31-year-old man with
recurrent glioblastoma multiforme. Axial contrast-enhanced CT scan obtained 1
day after surgery shows blood in surgical bed (arrows).
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2003 by the American Roentgen Ray Society.
