Diffusion restriction in a non-enhancing metastatic brain tumor treated with bevacizumab - recurrent tumor or atypical necrosis?

Clin Imaging. 2014 Sep-Oct;38(5):724-6. doi: 10.1016/j.clinimag.2014.04.014. Epub 2014 May 6.

Abstract

A 38-year-old female with metastatic brain cancer developed non-enhancing, diffusion restricted lesions following bevacizumab treatment. From our review of the literature, this is the first reported case of this type of lesion. Clinicians should be wary of these lesions, as they can represent either tumor progression or necrosis/effects of chronic hypoxia from anti-angiogenic therapy. Further investigation is necessary to determine the biological mechanism and clinical significance of this type of imaging appearance.

Keywords: Atypical necrosis; Bevacizumab; Brain metastases; DWI; Recurrent tumor.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Angiogenesis Inhibitors / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Bevacizumab
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / secondary*
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / secondary*
  • Diagnosis, Differential
  • Female
  • Humans
  • Necrosis / diagnosis
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local / diagnosis*
  • Occipital Lobe / pathology*
  • Parietal Lobe / pathology*

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab