PMC9763264_01
Pre- and post-surgery MRI. (A) Postcontrast T1-weighted MRI obtained 20 weeks following the completion of pLDR and two weeks before redo-surgery. (B) Corresponding maps of FTB superimposed on the postcontrast T1-weighted MRI images. The FTB maps show areas of active tumor (red), treatment effect (blue), and transitional zone (yellow). (C) Immediate post-operative postcontrast T1-weighted MRI demonstrating extent of resection. (D) Distribution of T1-weighted enhancement volume based on vascularization as measured by FTB maps.
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Figure 1A ) was observed in the setting of the patient experiencing neurocognitive decline. FTB maps revealed predominantly treatment effect with 70.3% non-tumor, 22.9% tumor admixture, and 6.8% tumor tissue ( Figures 1B, D ). MRI ( Figure 1C ). Microscopy of the five tissue specimens revealed a combination of necrosis, hyalinized and necrotic blood vessels, chronic inflammation, foamy macrophages, mineralization, and reactive gliosis, consistent with treatment effect.
PMC9763264_02
Pre- and post-surgery MRI. (A) Postcontrast T1-weighted MRI obtained five weeks post-pLDR and two weeks before redo-surgery. (B) Corresponding maps of FTB superimposed on the postcontrast T1-weighted MRI images. The FTB maps show areas of active tumor (red), treatment effect (blue), and transitional zone (yellow). (C) Post-surgery (four weeks) postcontrast T1-weighted MRI demonstrating extent of resection. (D) Distribution of T1-weighted enhancement volume based on vascularization as measured by FTB maps.
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Figure 2A ). FTB maps revealed predominantly treatment effect within the contrast enhancement surrounding the resection cavity with 84.0% non-tumor, 9.6% tumor admixture, and 6.4% tumor ( Figures 2B, D ). Reduced vasogenic edema and regions of enhancement around the resection cavity were later confirmed by MRI performed four weeks post-surgery ( Figure 2C ).
PMC9763264_03
Pre- and post-surgery MRI. (A) Postcontrast T1-weighted MRI obtained four weeks post-pLDR treatment and one week before redo-surgery. (B) Corresponding maps of FTB superimposed on the postcontrast T1-weighted MRI images. The FTB maps show areas of active tumor (red), treatment effect (blue), and transitional zone (yellow). (C) Post-surgery (one week) postcontrast T1-weighted MRI demonstrating extent of resection. (D) Distribution of T1-weighted enhancement volume based on vascularization as measured by FTB maps.
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Figure 3A ). FTB maps revealed predominantly treatment effect within the contrast enhancement surrounding the resection cavity with 64.6% non-tumor, 19.1% tumor admixture, and 16.4% tumor ( Figures 3B, D ). At one week post-surgery, brain MRI demonstrated retraction of the resection cavity and decreased peripheral enhancement along the surgical margins ( Figure 3C ).
PMC9763264_04
Pre- and post-surgery MRI. (A) Postcontrast T1-weighted MRI obtained 20 weeks post-pLDR and 10 weeks before redo-surgery. (B) Corresponding maps of FTB superimposed on the postcontrast T1-weighted MRI images. The FTB maps show areas of active tumor (red), treatment effect (blue), and transitional zone (yellow). (C) Immediate post-operative postcontrast T1-weighted MRI with FLAIR demonstrating extent of resection, which encompasses regions of tumor identified in the FTB maps. (D) Distribution of T1-weighted enhancement volume based on vascularization as measured by FTB maps.
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Figure 4A ). FTB maps were again obtained with increasing proportions of vascular tumor tissue suggesting progression: 42.9% non-tumor, 13.5% tumor admixture, and 43.6% tumor ( Figures 4B, D ). Significant debulking was later confirmed by MRI ( Figure 4C ).