Differentiation of radiation necrosis from tumor progression using proton magnetic resonance spectroscopy

We report on a young woman who was treated by stereotactic radiotherapy for recurrence of an initially resected low-grade astrocytoma. MRI follow-up examination 7 months after radiotherapy showed a gadolinium-DTPA-enhancing mass lesion indicative of high-grade tumor progression. This assumption was also supported by positron emission tomography with [2-F-18]fluoro-2-deoxy-D-glucose (FDG-PET). In contrast, proton MR spectroscopy (H-1-MRS) indicated radiation necrosis, which was confirmed histopathologically in surgical specimens. Subsequent follow-up examinations up to 19 months after surgery showed no evidence of tumor recurrence.