What is less enhancement on MRI?

[akoo]

I had my MRI 6 months (in Jan 2011) after my FRS in June 2010. The MRI report says "With gadolinium administration, patchy enhancement within the mass".
Anyone know what is the meaning of patchy enhancement.

I am also more than year post my FSR, but I have been getting headaches and/or giddiness for the last few months (3-4 times a month lastly 1-2 days each time). I wonder if it is normal. The radiologists apparently does not think I need another MRI scan until Jan 2011. Any reason to suspect anything is wrong?

[Tumbleweed]

akoo, I've never heard the exact phrase "patchy enhancement" used before. You should ask your doctor for clarification. But it sounds to me like your tumor is probably showing signs of necrosis -- a very good thing. Here's why:

A live tumor shows up white (enhanced) with contrast agent applied during an MRI. As the tumor begins to die (following radiation treatment), the dead tissue shows up black (not enhanced). This black and white spottiness (parts of the tumor still alive, parts of it dead), I would think, is what your doctor is probably referring to when they note "patchy enhancement."

It's important to note that dead scar tissue also shows up white in an MRI with contrast. That's because scar tissue has no vascularity (blood flow). So, the usual progression of a tumor that's been irradiated is for it show in MRIs with contrast as at first all-white then spotty (black and white patches) and then finally all-white again, as the dead tissue finally becomes scar tissue. Some people's tumors never show the blotchy phase, presumably because it occurred between MRI sessions, yet their tumor's growth, in the overwhelming number of cases, is nevertheless halted.

Best wishes,
TW

[akoo]

Dear Tumbleweed,

Thanks for your advice. Congrats that your tumor actually shrank. I was told by my doctor that usually they just want to control the growth, and not to kill it.
For the last month, I have been having headaches and "strange"ness (not really giddy, but more like a stuff head feeling), and also worsening tinnitus. I was wondering is the tumor is growing or was it dying that cause this changes. Is it possible that a dying tumor will also cause headaches? I am quite quite sure there are changes, but not sure if it is for the better for worse.

Just saw my radiologist last week and he was not very concerned. I had my last MRI in Jan 2011 and will only need to do next one in Jan 2012. He didnt think it was serious enough to order a new MRI soon. Guess I have to try and bear with the symptoms for the next 5 months. What was your experience after 1 year from the treatment?

Best Wishes,
Akoo
 

[Tumbleweed]

Akoo:

Sorry for my brief response here; dinner has yet to be cooked and it's impossibly late at night to be eating!

The goal is to kill the tumor; that's what halts the growth. The goal is not to shrink the tumor, but sometimes that happens (for about 25% of CK patients).

There is no way to know whether your symptoms are caused by the tumor dying, swelling or growing (or simply because a cranial nerve or two is stressed). The important thing is whether or not the tumor is swelling or continuing to grow, which can only be determined by a follow-up MRI series. Internal swelling can also occur without an increase in size, and this can temporarily cause symptoms to flare up. The good news is these symptom flare-ups are almost always temporary.

After one year since being treated, I was feeling really great: balance 75% improved, tinnitus reduced 90%, energy level boosted considerably. In fact, I had improved that much after only six months. This despite having an unusually severe reaction to CK initially. My doctor theorized I felt so miserable because the tumor was dying quickly. So take heart: bad symptoms can mean good things!

Best wishes,
TW

[Vivian B.]

I think that the doctor meant that the tumor is shrinking. What I don't get is how can they tell if it dies or not if there is no contrast involved and they say they need no contrast, which is my case now. First 3 MRIs I had contrast prior to GK. One MRI after I had contrast, the next did not and the one coming up does not. They do say that the goal is to stop the growth but doesn't the radiation kill the tumor also eventually?
How will they know if no contrast is applied? I am confused but in your case I am glad they can see something shady meaning radiation is working.

Vivian

[mk]

Vivian,

changes in contrast (i.e. darkening or necrosis) typically happen only after the 1st year or so after radiation. Afterwards the tumor enhances again, due to the formation of scar tissue, which appears white. After the one year mark, all that matters is if the tumor is stable - this is obvious even without contrast, unless the tumor is too small. The modern instruments they have at TWH these days have pretty good resolution even without contrast.

Marianna