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Case Reports
. 2018 Nov 14:15:1-6.
doi: 10.1016/j.ctro.2018.11.004. eCollection 2019 Feb.

Radiation-induced vascular malformations in the brain, mimicking tumor in MRI-based treatment response assessment maps (TRAMs)

David Guez  1 , David Last  1 , Dianne Daniels  1 , Shirley Sharabi  1 , Dvora Nass  2   3 , Ouzi Nissim  4 , Roberto Spiegelmann  4   3 , Galia Tzarfaty  5   3 , Chen Hoffmann  5   3 , Alisa Talianski  6   3 , Yigal Shoshan  7 , Yakov Fellig  8 , Sagi Harnof  9   3 , Zvi R Cohen  4   3 , Leor Zach  6   3 , Yael Mardor  1   3
Affiliations
Case Reports

Radiation-induced vascular malformations in the brain, mimicking tumor in MRI-based treatment response assessment maps (TRAMs)

David Guez et al. Clin Transl Radiat Oncol. .

Abstract

•Of 310 brain tumors patients recruited, histology of 99 lesions was available.•Of those, 5 were histologically confirmed as radiation-induced malformations.•TRAMs cannot differentiate active tumor from vascular malformation.

Keywords: Brain tumors; MRI; RICM; RIT; Radiation; TRAMs; Vascular malformations.

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Figures

Fig. 1
Fig. 1
An example of radiation-induced vascular malformation in a patient with GBM post treatment (patient #2). A, B: Pre-surgical contrast-enhanced T1-weighted MRI and the calculated TRAMs depicting a small blue mass within a surrounding thin blue rim. C: H&E stained paraffin section showing radiation-induced cavernoma-like vascular malformation (arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
An example of radiation-induced vascular malformation in a patient with a non-small cell lung cancer brain metastasis post treatment (patient #3). A, C: Pre-surgical contrast-enhanced T1-weighted MRI and the calculated TRAMs depicting a small blue mass on the border of the previous surgery site 29 months post SRS. B, D: Pre-surgical contrast-enhanced T1-weighted MRI and the calculated TRAMs depicting a small blue mass re-growing on the border of the previous surgery site 23 months post removal of the previous lesion and FSR. E–H H&E stained paraffin sections showing cavernoma-like vascular malformations, with back to back vascular channels, marked hyalinization and calcification. H: Immuno-histochemical staining for smooth muscle alpha-actin (SMA) showing only patchy immuno-reactivity in vessel walls, with near-absence in areas. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
An example of radiation-induced vascular malformation in a patient with GBM post treatment (patient #4). A, B: Pre-surgical contrast-enhanced T1-weighted MRI and the calculated TRAMs depicting a small blue mass within a surrounding thin blue rim. C, D: H&E stained paraffin section showing radiation-induced cavernoma-like vascular malformation. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 4
Fig. 4
MRI of the patient 5–9 (patients with treated AVM). A–E: T1 of the five patients. F–J: TRAMs of the five patients.
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