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Fig. 6 | Cancer Imaging

Fig. 6

From: Improving the diagnosis of radiation necrosis after stereotactic radiosurgery to intracranial metastases with conventional MRI features: a case series

Fig. 6

Coronal post-contrast T1WI in a patient with a left caudate nucleus metastasis (a, dotted circle) from a small cell lung cancer primary, treated with SRS (24 Gy in 3 fractions). The first post-treatment MRI at five months (b) shows that the lesion has substantially enlarged to involve the adjacent corpus callosum (arrowhead), wrapping around the adjacent lateral ventricle. Note the lack of enhancement along the ventricular surface, producing an “open ring” appearance. The eccentric morphology of the enlargement (with respect to the initial lesion), predominantly occurring superomedially across the ventricle, is more in keeping with RN than PD, which was confirmed by subsequent regression. There was also geographic correlation with the radiation high dose region, as illustrated by the 24 Gy, 15 Gy and 10 Gy isodose lines (in decreasing grayscale brightness) from the SRS plan (c)

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