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Case Reports
. 2018 Apr 18;10(4):e2502.
doi: 10.7759/cureus.2502.

Imaging of Sodium MRI for Therapy Evaluation of Brain Metastase with Cyberknife at 7T: A Case Report

Lichao Huang  1 , Zihao Zhang  2 , Baolin Qu  3 , Zhiqiang Cui  1 , Yao Wang  3 , Jiwei Li  3 , Jinyuan Wang  3 , Zhentao Zuo  4 , Yan Zhuo  4 , Xinguang Yu  1 , Zhipei Lin  1 , Longsheng Pan  1
Affiliations
Case Reports

Imaging of Sodium MRI for Therapy Evaluation of Brain Metastase with Cyberknife at 7T: A Case Report

Lichao Huang et al. Cureus. .

Abstract

Herein we describe the case of an elderly patient who presented with a recent history of impaired vision of the right eye around three months due to brain lesions. He was diagnosed with liver cancer and underwent surgery three months prior. The pathological result is hepatocellular carcinoma. Magnetic resonance imaging (MRI) revealed the diagnosis of brain to be metastatic. The patient selected CyberKnife (Accuray Incorporated, Sunnyvale, USA) radiosurgery for the brain lesion since his physical conditions are not suitable for craniotomy. We adapt the imaging of sodium MRI and proton diffusion mapping at 7T MR system to evaluate the efficacy following CyberKnife early stage treatment. To date, we find the tissue sodium concentration (TSC) changes with the time whereas the proton MRI has no significant change within one month. The time course of sodium concentration in the tumor showed a dramatic increase in the treated brain tumor compared to the pretreatment sodium concentration and 48 hours after stereotactic radiosurgery (SRS), which is correlated to the period of the radiotherapy-induced cellular necrosis. This case demonstrates the possibility of sodium MRI as a biomarker for monitoring early radiotherapy for assessing tumor cellularity.

Keywords: brain metastase; cyberknife; sodium mri; tissue sodium concentration (tsc).

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Conflict of interest statement

We want to know if the co-author Zihao Zhang could be listed as co-first author?

Figures

Figure 1
Figure 1. Initial T1 Contrast-enhanced magnetic resonance imaging
Axial (A),Coronal (B) and Sagittal (C) T1 Contrast-enhanced MRI imaging revealed an cranio-orbital tumor(arrow).
Figure 2
Figure 2. CyberKnife radiosurgery planing
Figure 3
Figure 3. Cyberknife radiosurgery planing
Figure 4
Figure 4. T2-weight imaging and sodium MRI.
Axial T2-weight MRI with pretreatment (A), 48 hours after treatment (B), post-treatment of 1 week (C) and post-treatment of 1 month (D). Axial Sodium MRI Images with pretreatment (E)  48 hours after treatment (B), post-treatment of 1 week (C), post-treatment of 1 month (D)
Figure 5
Figure 5. The TSC ratio of tumor and cerebrospinal fluid
The sodium signal intensity of ROI (region of interest) located in the center of tumor (A) as well as the sodium signal intensity of CSF in lateral ventricle (B) were quantified. The ratio of sodium signal intensity in tumor and CSF is shown clearly (C).
See this image and copyright information in PMC

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