{"id":99,"date":"2013-02-21T18:46:14","date_gmt":"2013-02-21T18:46:14","guid":{"rendered":"https:\/\/docneuro.jz7sunfr-liquidwebsites.com\/residual-recurrent-tumor\/"},"modified":"2013-02-21T18:46:14","modified_gmt":"2013-02-21T18:46:14","slug":"residual-recurrent-tumor","status":"publish","type":"post","link":"https:\/\/docneuro.com\/residual-recurrent-tumor\/","title":{"rendered":"Residual\/Recurrent Tumor"},"content":{"rendered":"<p>Imaging plays an important role in the diagnosis and management of patients with primary brain neoplasms. In particular, imaging is typically performed within 48 hours of tumor resection.<\/p>\n<p>  <!--more-->  <\/p>\n<h2>Diagnosis: Residual GBM after surgery<\/h2>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\" size-full wp-image-422\" src=\"https:\/\/docneuro.com\/wp-content\/uploads\/2013\/02\/residual_recurrent_tumor_marked.jpg\" border=\"0\" style=\"border: 0;\" width=\"600\" height=\"305\" srcset=\"https:\/\/docneuro.com\/wp-content\/uploads\/2013\/02\/residual_recurrent_tumor_marked.jpg 600w, https:\/\/docneuro.com\/wp-content\/uploads\/2013\/02\/residual_recurrent_tumor_marked-300x153.jpg 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<p><strong>Figure 1: <\/strong>(a, red arrrow) Pre and immediate post operative (b, blue arrow) MRI imaging of a GBM demonstrates decreased but persistent enhancement within the surgical bed, consistent with recurrent tumor . Granulation tissue takes more than 48 hours to develop.<\/p>\n<p>The goals of imaging at this timepoint are to:<\/p>\n<p>1. Assess for residual tumor and establish a new imaging baseline.<\/p>\n<ul>\n<ul>\n<ul>\n<li><span style=\"line-height: 1.3em;\">Since granulation tissue takes more than 48 hours to form, mass like enhancement in the surgical bed in immediate post operative imaging is consistent with residual tumor.<\/span><\/li>\n<\/ul>\n<\/ul>\n<\/ul>\n<p><span style=\"line-height: 1.3em;\">2. Look for signs of infarct.<\/span><\/p>\n<ul>\n<ul>\n<ul>\n<li><span style=\"line-height: 1.3em;\">While non territorial infarcts are common after surgery, they are important to identify because subacute infarcts can enhance for months and therefore mimic tumor recurrence on subsequent imaging.<\/span><\/li>\n<\/ul>\n<\/ul>\n<\/ul>\n<p><span style=\"line-height: 1.3em;\">3. Recognize expected post operative changes:<\/span><\/p>\n<ul>\n<ul>\n<ul>\n<li><span style=\"line-height: 1.3em;\">DWI : Ischemia\/infarct due to retraction, small vessel damage,<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Pneumocephalus, and<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Small amount of intra and\/or extra axial blood (mimic of enhancement).<\/span><\/li>\n<\/ul>\n<\/ul>\n<\/ul>\n<p><span style=\"line-height: 1.3em;\">4. Look for unexpected post operative complications:<\/span><\/p>\n<ul>\n<ul>\n<ul>\n<li><span style=\"line-height: 1.3em;\">Territorial ischemia,<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Large intracerebral hemorrhage,<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Venous sinus thrombosis,<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Hydrocephalus, and<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">CSF leak pseudomeningocele.<\/span><\/li>\n<\/ul>\n<\/ul>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Imaging plays an important role in the diagnosis and management of patients with primary brain neoplasms. In particular, imaging is typically performed within 48 hours of tumor resection.<\/p>\n","protected":false},"author":3,"featured_media":422,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[17],"tags":[267,266,265],"aioseo_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Residual\/Recurrent Tumor - DocNeuro<\/title>\n<meta name=\"description\" content=\"Differentiating recurrent brain tumors from new lesions using neuro-radiological tools.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/docneuro.com\/residual-recurrent-tumor\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Residual\/Recurrent Tumor - 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