Neuroimaging in Radiosurgery Treatment Planning and Follow-up Evaluation

  • Clark C. Chen
  • Paul H. Chapman
  • Hanne Kooy
  • Jay S. Loeffler


Radiosurgery refers to the precise delivery of a large, single dose of radiation to a focal target. The focal dose distribution allows for a positive therapeutic gain. Because of the opacity of the cranial vault, target volume definition relies entirely on the anatomic accuracy of the available imaging modalities. The need for accurate anatomic visualization is magnified by the use of higher radiation dose delivered in radiosurgery as compared with radiotherapy. To achieve maximal spatial accuracy in radiosurgical planning, an understanding of the basic principles underlying neuroimaging as well as the limitations associated with each imaging modality is mandatory. Additionally, the optimal management of patients after radiosurgery requires knowledge of the expected neuroimaging changes as they relate to clinical outcome. These issues will be reviewed in this chapter.


Malignant Glioma Radiat Oncol Biol Phys Arteriovenous Malformation Trigeminal Neuralgia Cerebral Blood Volume 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Battista J, Rider W, Van DJ. Computed tomography for radiotherapy planning. Int J Radiat Oncol Biol Phys 1980; 6:99–107.PubMedGoogle Scholar
  2. 2.
    Nelson SJ, Cha S. Imaging glioblastoma multiforme. Cancer J 2003; 9:134–145.PubMedCrossRefGoogle Scholar
  3. 3.
    Sumanaweera TS et al. Characterization of spatial distortion in magnetic resonance imaging and its implications for stereotactic surgery. Neurosurgery 1994; 35:696–703; discussion 703–704.PubMedCrossRefGoogle Scholar
  4. 4.
    Chang H, Fitzpatrick JM. A technique for accurate magnetic resonance imaging in the presence of field inhomogeneities. IEEE Trans Med Imaging 1992; 11:319–329.PubMedCrossRefGoogle Scholar
  5. 5.
    Sumanaweera T et al. MR susceptibility misregistration correction. IEEE Trans Med Imaging 1993; 12:251–259.PubMedCrossRefGoogle Scholar
  6. 6.
    Sumanaweera T et al. Quantifying MRI geometric distortion in tissue. Magn Reson Med 1994; 31:40–47.PubMedCrossRefGoogle Scholar
  7. 7.
    Mack A et al. Analyzing 3-tesla magnetic resonance imaging units for implementation in radiosurgery. J Neurosurg 2005; 102(Suppl):158–164.PubMedCrossRefGoogle Scholar
  8. 8.
    Bednarz G et al. Evaluation of the spatial accuracy of magnetic resonance imaging-based stereotactic target localization for gamma knife radiosurgery of functional disorders. Neurosurgery 1999; 45:1156–1161; discussion 1161–113.PubMedCrossRefGoogle Scholar
  9. 9.
    Kondziolka D et al. A comparison between magnetic resonance imaging and computed tomography for stereotactic coordinate determination. Neurosurgery 1992; 30:402–406; discussion 406–407.PubMedCrossRefGoogle Scholar
  10. 10.
    Orth RC et al. Development of a unique phantom to assess the geometric accuracy of magnetic resonance imaging for stereotactic localization. Neurosurgery 1999; 45:1423–1429; discussion 1429–1431.PubMedCrossRefGoogle Scholar
  11. 11.
    Walton L et al. A phantom study to assess the accuracy of stereotactic localization, using T1-weighted magnetic resonance imaging with the Leksell stereotactic system. Neurosurgery 1996; 38:170–176; discussion 176–178.PubMedCrossRefGoogle Scholar
  12. 12.
    Walton L et al. Stereotactic localization with magnetic resonance imaging: a phantom study to compare the accuracy obtained using two-dimensional and three-dimensional data acquisitions. Neurosurgery 1997; 41:131–137; discussion 137–139.PubMedCrossRefGoogle Scholar
  13. 13.
    Task Force on Stereotactic Radiosurgery. Consensus statement on stereotactic radiosurgery quality improvement. The American Society for Therapeutic Radiology and Oncology, Task Force on Stereotactic Radiosurgery and the American Association of Neurological Surgeons. Int J Radiat Oncol Biol Phys 1994; 28:527–530.Google Scholar
  14. 14.
    Khoo VS et al. Magnetic resonance imaging (MRI): considerations and applications in radiotherapy treatment planning. Radiother Oncol 1997; 42:1–15.PubMedCrossRefGoogle Scholar
  15. 15.
    Shaw E et al. Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 1993; 27:1231–1239.PubMedGoogle Scholar
  16. 16.
    Schad LR et al. Radiotherapy treatment planning of basal meningiomas: improved tumor localization by correlation of CT and MR imaging data. Radiother Oncol 1992; 25:56–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Just M et al. MRI-assisted radiation therapy planning of brain tumors—clinical experiences in 17 patients. Magn Reson Imaging 1991; 9:173–177.PubMedCrossRefGoogle Scholar
  18. 18.
    Shuman WP et al. MR imaging in radiation therapy planning. Work in progress. Radiology 1985; 156:143–147.PubMedGoogle Scholar
  19. 19.
    Shuman WP et al. The utility of MR in planning the radiation therapy of oligodendroglioma. AJR Am J Roentgenol 1987; 148:595–600.PubMedGoogle Scholar
  20. 20.
    Ten Haken RK et al. A quantitative assessment of the addition of MRI to CT-based, 3-D treatment planning of brain tumors. Radiother Oncol 1992; 25:121–133.PubMedCrossRefGoogle Scholar
  21. 21.
    De Salles AA et al. Transposition of target information from the magnetic resonance and computed tomography scan images to conventional X-ray stereotactic space. Appl Neurophysiol 1987; 50:23–32.PubMedGoogle Scholar
  22. 22.
    Pelizzari CA et al. Accurate three-dimensional registration of CT, PET, and/or MR images of the brain. J Comput Assist Tomogr 1989; 13:20–26.PubMedCrossRefGoogle Scholar
  23. 23.
    Judnick JW et al. Radiotherapy technique integrates MRI into CT. Radiol Technol 1992; 64:82–89.PubMedGoogle Scholar
  24. 24.
    Evans PM et al. Image comparison techniques for use with megavoltage imaging systems. Br J Radiol 1992; 65:701–709.PubMedCrossRefGoogle Scholar
  25. 25.
    Kelly PJ et al. Stereotactic histologic correlations of computed tomography-and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc 1987; 62:450–459.PubMedGoogle Scholar
  26. 26.
    Apisarnthanarax S, Chao KS. Current imaging paradigms in radiation oncology. Radiat Res 2005; 163:1–25.PubMedCrossRefGoogle Scholar
  27. 27.
    Tralins KS et al. Volumetric analysis of 18F-FDG PET in glioblastoma multiforme: prognostic information and possible role in definition of target volumes in radiation dose escalation. J Nucl Med 2002; 43:1667–1673.PubMedGoogle Scholar
  28. 28.
    Gross MW et al. The value of F-18-fluorodeoxyglucose PET for the 3-D radiation treatment planning of malignant gliomas. Int J Radiat Oncol Biol Phys 1998; 41:989–995.PubMedGoogle Scholar
  29. 29.
    Pardo FS et al. Functional cerebral imaging in the evaluation and radiotherapeutic treatment planning of patients with malignant glioma. Int J Radiat Oncol Biol Phys 1994; 30:663–669.PubMedGoogle Scholar
  30. 30.
    Nuutinen J et al. Radiotherapy treatment planning and long-term follow-up with [(11)C]methionine PET in patients with low-grade astrocytoma. Int J Radiat Oncol Biol Phys 2000; 48:43–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Pirzkall A et al. MR-spectroscopy guided target delineation for high-grade gliomas. Int J Radiat Oncol Biol Phys 2001; 50:915–928.PubMedCrossRefGoogle Scholar
  32. 32.
    Chan A, Nelson S. Use of 1H magnetic resonance spectroscopic imaging in managing recurrent glioma patients undergoing radiosurgery. ISMRM Workshop Proceedings on MR of Cancer 2002;227.Google Scholar
  33. 33.
    Chan AA et al. Proton magnetic resonance spectroscopy imaging in the evaluation of patients undergoing gamma knife surgery for Grade IV glioma. J Neurosurg 2004; 101:467–475.PubMedCrossRefGoogle Scholar
  34. 34.
    Graves EE et al. A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. Neurosurgery 2000; 46:319–326; discussion 26–28.PubMedCrossRefGoogle Scholar
  35. 35.
    Graves EE et al. Serial proton MR spectroscopic imaging of recurrent malignant gliomas after gamma knife radiosurgery. AJNR Am J Neuroradiol 2001; 22:613–624.PubMedGoogle Scholar
  36. 36.
    McKnight TR et al. Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence. J Neurosurg 2002; 97:794–802.PubMedCrossRefGoogle Scholar
  37. 37.
    Nelson SJ et al. In vivo molecular imaging for planning radiation therapy of gliomas: an application of 1H MRSI. J Magn Reson Imaging 2002; 16:464–476.PubMedCrossRefGoogle Scholar
  38. 38.
    Cha S. Perfusion MR imaging: basic principles and clinical applications. Magn Reson Imaging Clin N Am 2003; 11:403–413.PubMedCrossRefGoogle Scholar
  39. 39.
    Cha S. Perfusion MR imaging of brain tumors. Top Magn Reson Imaging 2004; 15:279–289.PubMedCrossRefGoogle Scholar
  40. 40.
    Castillo M et al. Apparent diffusion coefficients in the evaluation of high-grade cerebral gliomas. AJNR Am J Neuroradiol 2001; 22:60–64.PubMedGoogle Scholar
  41. 41.
    Moffat BA et al. Functional diffusion map: a noninvasive MRI biomarker for early stratification of clinical brain tumor response. Proc Natl Acad Sci USA 2005; 102:5524–5529.PubMedCrossRefGoogle Scholar
  42. 42.
    Nelson S. Imaging of brain tumors after therapy. Neuroimaging Clin N Am 1999; 9:801–819.PubMedGoogle Scholar
  43. 43.
    Benjamin R, Capparella J, Brown A. Classification of glioblastoma multiforme in adults by molecular genetics. Cancer J 2003; 9:982–990.CrossRefGoogle Scholar
  44. 44.
    Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65:476–483.PubMedCrossRefGoogle Scholar
  45. 45.
    Flickinger JC, Kondziolka D, Lunsford LD. Clinical applications of stereotactic radiosurgery. Cancer Treat Res 1998; 93:283–297.PubMedGoogle Scholar
  46. 46.
    Friedman WA. LINAC radiosurgery. Neurosurg Clin N Am 1990; 1:991–1008.PubMedGoogle Scholar
  47. 47.
    Friedman WA, Bova FJ. Linear accelerator radiosurgery for arteriovenous malformations. J Neurosurg 1992; 77:832–841.PubMedCrossRefGoogle Scholar
  48. 48.
    Friedman WA, Bova FJ, Mendenhall WM. Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. J Neurosurg 1995; 82:180–189.PubMedCrossRefGoogle Scholar
  49. 49.
    Friedman WA, Bova FJ, Spiegelmann R. Linear accelerator radiosurgery at the University of Florida. Neurosurg Clin N Am 1992; 3:141–166.PubMedGoogle Scholar
  50. 50.
    Kondziolka D, Lunsford LD. The case for and against AVM radiosurgery. Clin Neurosurg 2001; 48:96–110.PubMedGoogle Scholar
  51. 51.
    Lunsford LD et al. Stereotactic radiosurgery of brain vascular malformations. Neurosurg Clin N Am 1992; 3:79–98.PubMedGoogle Scholar
  52. 52.
    Pollock BE et al. Patient outcomes after stereotactic radiosurgery for “operable” arteriovenous malformations. Neurosurgery 1994; 35:1–7; discussion 7–8PubMedCrossRefGoogle Scholar
  53. 53.
    Steiner L et al. Clinical outcome of radiosurgery for cerebral arteriovenous malformations. J Neurosurg 1992; 77:1–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Colombo F et al. Three-dimensional angiography for radiosurgical treatment planning for arteriovenous malformations. J Neurosurg 2003; 98:536–543.PubMedCrossRefGoogle Scholar
  55. 55.
    Blatt DR, Friedman WA, Bova FJ. Modifications based on computed tomographic imaging in planning the radiosurgical treatment of arteriovenous malformations. Neurosurgery 1993; 33:588–595; discussion 595—596.PubMedCrossRefGoogle Scholar
  56. 56.
    Kondziolka D et al. Stereotactic magnetic resonance angiography for targeting in arteriovenous malformation radiosurgery. Neurosurgery 1994; 35:585–590; discussion 590–591.PubMedCrossRefGoogle Scholar
  57. 57.
    Levy RP et al. Computed tomography slice-by-slice target-volume delineation for stereotactic proton irradiation of large intracranial arteriovenous malformations: an iterative approach using angiography, computed tomography, and magnetic resonance imaging. Int J Radiat Oncol Biol Phys 1996; 35:555–564.PubMedCrossRefGoogle Scholar
  58. 58.
    Aoyama H et al. Comparison of imaging modalities for the accurate delineation of arteriovenous malformation, with reference to stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2005; 62:1232–1238.PubMedGoogle Scholar
  59. 59.
    Tanaka H et al. Initial experience with helical CT and 3D reconstruction in therapeutic planning of cerebral AVMs: comparison with 3D time-of-flight MRA and digital subtraction angiography. J Comput Assist Tomogr 1997; 21:811–817.PubMedCrossRefGoogle Scholar
  60. 60.
    Kakizawa Y et al. Compartments in arteriovenous malformation nidi demonstrated with rotational three-dimensional digital subtraction angiography by using selective microcatheterization. Report of three cases. J Neurosurg 2002; 96:770–774.PubMedCrossRefGoogle Scholar
  61. 61.
    Debus J et al. Brainstem tolerance to conformal radiotherapy of skull base tumors. Int J Radiat Oncol Biol Phys 1997; 39:967–975.PubMedGoogle Scholar
  62. 62.
    Debus J et al. Dose-volume tolerance of the brainstem after high-dose radiotherapy. Front Radiat Ther Oncol 1999; 33:305–314.PubMedCrossRefGoogle Scholar
  63. 63.
    Flickinger JC et al. Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group. Int J Radiat Oncol Biol Phys 2000; 46:1143–1148.PubMedGoogle Scholar
  64. 64.
    Leber KA, Bergloff J, Pendl G. Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 1998; 88:43–50.PubMedCrossRefGoogle Scholar
  65. 65.
    Tishler RB et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993; 27:215–221.PubMedGoogle Scholar
  66. 66.
    Foote KD et al. Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 2001; 95:440–449.PubMedCrossRefGoogle Scholar
  67. 67.
    Huber PE et al. Transient enlargement of contrast uptake on MRI after linear accelerator (linac) stereotactic radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 2001; 49:1339–1349.PubMedGoogle Scholar
  68. 68.
    Ross DA et al. Imaging changes after stereotactic radiosurgery of primary and secondary malignant brain tumors. J Neurooncol 2002; 56:175–181.PubMedCrossRefGoogle Scholar
  69. 69.
    Auchter RM et al. A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 1996; 35:27–35.PubMedGoogle Scholar
  70. 70.
    Engenhart R et al. Long-term follow-up for brain metastases treated by percutaneous stereotactic single high-dose irradiation. Cancer 1993; 71:1353–1361.PubMedCrossRefGoogle Scholar
  71. 71.
    Flickinger JC et al. Radiosurgery: its role in brain metastasis management. Neurosurg Clin N Am 1996; 7:497–504.PubMedGoogle Scholar
  72. 72.
    Mehta MP et al. Stereotactic radiosurgery for glioblastoma multiforme: report of a prospective study evaluating prognostic factors and analyzing long-term survival advantage. Int J Radiat Oncol Biol Phys 1994; 30:541–549.PubMedGoogle Scholar
  73. 73.
    Shrieve DC et al. Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 1995; 36:275–282; discussion 82–84.PubMedCrossRefGoogle Scholar
  74. 74.
    Rabinov JD et al. In vivo 3-T MR spectroscopy in the distinction of recurrent glioma versus radiation effects: initial experience. Radiology 2002; 225:871–879.PubMedCrossRefGoogle Scholar
  75. 75.
    Tsuyuguchi N et al. Methionine positron emission tomography for differentiation of recurrent brain tumor and radiation necrosis after stereotactic radiosurgery—in malignant glioma. Ann Nucl Med 2004; 18:291–296.PubMedCrossRefGoogle Scholar
  76. 76.
    Kimura T et al. Evaluation of the response of metastatic brain tumors to stereotactic radiosurgery by proton magnetic resonance spectroscopy, 201TlCl single-photon emission computerized tomography, and gadolinium-enhanced magnetic resonance imaging. J Neurosurg 2004; 100:835–841.PubMedCrossRefGoogle Scholar
  77. 77.
    Essig M et al. Assessment of brain metastases with dynamic susceptibility-weighted contrast-enhanced MR imaging: initial results. Radiology 2003; 228:193–199.PubMedCrossRefGoogle Scholar
  78. 78.
    Wald LL et al. Serial proton magnetic resonance spectroscopy imaging of glioblastoma multiforme after brachytherapy. J Neurosurg 1997; 87:525–534.PubMedCrossRefGoogle Scholar
  79. 79.
    Lunsford LD et al. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005; 102(Suppl):195–199.PubMedCrossRefGoogle Scholar
  80. 80.
    Harsh G et al. Proton beam stereotactic radiosurgery of vestibular schwannomas. Int J Radiat Oncol Biol Phys 2002; 54:35–44.PubMedGoogle Scholar
  81. 81.
    Karpinos M et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 2002; 54:1410–1421.PubMedGoogle Scholar
  82. 82.
    Pollock B et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 1995; 36:215–224.PubMedCrossRefGoogle Scholar
  83. 83.
    Prasad D, Steiner M, Steiner L. Gamma surgery for vestibular schwannoma. Neurosugery 2000; 92:745–759.CrossRefGoogle Scholar
  84. 84.
    Petit J et al. Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 2001; 49:1299–1306.PubMedCrossRefGoogle Scholar
  85. 85.
    Karpinos M et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 2002; 54:1410–1421.PubMedGoogle Scholar
  86. 86.
    Linskey ME, Lunsford LD, Flickinger JC. Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR Am J Neuroradiol 1991; 12:1165–1175.PubMedGoogle Scholar
  87. 87.
    Nakamura H et al. Serial follow-up MR imaging after gamma knife radiosurgery for vestibular schwannoma. AJNR Am J Neuroradiol 2000; 21:1540–1546.PubMedGoogle Scholar
  88. 88.
    Hirato M et al. Gamma knife radiosurgery for acoustic schwannoma: early effects and preservation of hearing. Neurol Med Chir (Tokyo) 1995; 35:737–741.CrossRefGoogle Scholar
  89. 89.
    Kobayashi T, Tanaka T, Kida Y. The early effects of gamma knife on 40 cases of acoustic neurinoma. Acta Neurochir Suppl 1994; 62:93–97.PubMedGoogle Scholar
  90. 90.
    Tung GA et al. MR imaging of pituitary adenomas after gamma knife stereotactic radiosurgery. AJR Am J Roentgenol 2001; 177:919–924.PubMedGoogle Scholar
  91. 91.
    Sawamura Y et al. Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 2003; 99:685–692.PubMedCrossRefGoogle Scholar
  92. 92.
    Pirouzmand F, Tator CH, Rutka J. Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 2001; 48:1246–1253; discussion 53–54.PubMedCrossRefGoogle Scholar
  93. 93.
    Cheshire WP. Trigeminal neuralgia: diagnosis and treatment. Curr Neurol Neurosci Rep 2005; 5:79–85.PubMedCrossRefGoogle Scholar
  94. 94.
    Alberico RA, Fenstermaker RA, Lobel J. Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia. AJNR Am J Neuroradiol 2001; 22:1944–1948.PubMedGoogle Scholar
  95. 95.
    Cheuk AV et al. Gamma knife surgery for trigeminal neuralgia: outcome, imaging, and brainstem correlates. Int J Radiat Oncol Biol Phys 2004; 60:537–541.PubMedGoogle Scholar
  96. 96.
    Kondziolka D, Lunsford LD, Flickinger JC. Gamma knife radio-surgery as the first surgery for trigeminal neuralgia. Stereotact Funct Neurosurg 1998; 70(Suppl 1):187–191.PubMedCrossRefGoogle Scholar
  97. 97.
    Urgosik D et al. Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study. Stereotact Funct Neurosurg 1998; 70(Suppl 1):200–209.PubMedGoogle Scholar
  98. 98.
    Young RF et al. Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology 1997; 48:608–614.PubMedGoogle Scholar
  99. 99.
    Friedman DP, Morales RE, Goldman HW. Role of enhanced MRI in the follow-up of patients with medically refractory trigeminal neuralgia undergoing stereotactic radiosurgery using the gamma knife: initial experience. J Comput Assist Tomogr 2001; 25:727–732.PubMedCrossRefGoogle Scholar
  100. 100.
    Morikawa M et al. Radiosurgery for cerebral arteriovenous malformations: assessment of early phase magnetic resonance imaging and significance of gadolinium-DTPA enhancement. Int J Radiat Oncol Biol Phys 1996; 34:663–675.PubMedGoogle Scholar
  101. 101.
    Lunsford LD et al. Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 1991; 75:512–524.PubMedCrossRefGoogle Scholar
  102. 102.
    Yamamoto M et al. Long-term results of radiosurgery for arteriovenous malformation: neurodiagnostic imaging and histological studies of angiographically confirmed nidus obliteration. Surg Neurol 1992; 37:219–230.PubMedCrossRefGoogle Scholar
  103. 103.
    Kauczor HU et al. 3D TOF MR angiography of cerebral arteriovenous malformations after radiosurgery. J Comput Assist Tomogr 1993; 17:184–190.PubMedCrossRefGoogle Scholar
  104. 104.
    Oppenheim C et al. Radiosurgery of cerebral arteriovenous malformations: is an early angiogram needed? AJNR Am J Neuroradiol 1999; 20:475–481.PubMedGoogle Scholar
  105. 105.
    Young C et al. Radiosurgery for arteriovenous malformations: the University of Toronto experience. Can J Neurol Sci 1997; 24:99–105.PubMedGoogle Scholar
  106. 106.
    Loeffler JS et al. Stereotactic radiosurgery of the brain using a standard linear accelerator: a study of early and late effects. Radiother Oncol 1990; 17:311–321.PubMedCrossRefGoogle Scholar
  107. 107.
    Marks MP et al. Intracranial vascular malformations: imaging of charged-particle radiosurgery. Part II. Complications. Radiology 1988; 168:457–462.PubMedGoogle Scholar
  108. 108.
    Abe T et al. Magnetic resonance angiography of cerebral arteriovenous malformations. Neurol Med Chir (Tokyo) 1995; 35:580–583.CrossRefGoogle Scholar
  109. 109.
    Noorbehesht B, Fabrikant JI, Enzmann DR. Size determination of supratentorial arteriovenous malformations by MR, CT and angio. Neuroradiology 1987; 29:512–518.PubMedCrossRefGoogle Scholar
  110. 110.
    Quisling RG et al. Persistent nidus blood flow in cerebral arteriovenous malformation after stereotactic radiosurgery: MR imaging assessment. Radiology 1991; 180:785–791.PubMedGoogle Scholar
  111. 111.
    Flickinger JC et al. Radiosurgery and brain tolerance: an analysis of neurodiagnostic imaging changes after gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 1992; 23:19–26.PubMedGoogle Scholar
  112. 112.
    Guo WY et al. Gamma knife surgery of cerebral arteriovenous malformations: serial MR imaging studies after radiosurgery. Int J Radiat Oncol Biol Phys 1993; 25:315–323.PubMedGoogle Scholar
  113. 113.
    Shin M et al. Risk of hemorrhage from an arteriovenous malformation confirmed to have been obliterated on angiography after stereotactic radiosurgery. J Neurosurg 2005; 102:842–846.PubMedCrossRefGoogle Scholar
  114. 114.
    Loeffler JS, Niemierko A, Chapman PH. Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurgery 2003; 52:1436–1440.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Clark C. Chen
    • 1
  • Paul H. Chapman
    • 1
  • Hanne Kooy
    • 2
  • Jay S. Loeffler
    • 2
  1. 1.Radiosurgery, Department of NeurosurgeryMassachusetts General HospitalBostonUSA
  2. 2.Department of Radiation OncologyMassachusetts General HospitalBostonUSA

Personalised recommendations