Dear OncoLink "Ask The Experts,"
My daughter's last MRI showed a very bright thick ring - a complete circle - around her brain tumor that was not there just 8 months ago. The shape of the tumor has changed a bit, too. Her tumor was removed 7 years ago. The doctor said, worst case scenario would be that it is now malignant with no cure. But he tells me to not worry and that she should have another MRI in 3 months. Any advice will help.
Robert Lustig MD FACR, Clinical Associate Professor, Department of Radiation Oncology, University of Pennsylvania, responds:
It sounds like your daughter initially presented with a low-grade brain tumor that was resected (surgically removed) 7 years ago. They are generally slow-growing and less invasive into the surrounding brain, making them somewhat easier to remove surgically, compared to higher grade tumors. However, low-grade tumors can recur many years after treatment. Sometimes they can recur at a more advanced grade than before. I would recommend a repeat MRI in 6 weeks along with MR spectroscopy. If there is any concern on the spectroscopy study, then surgery should be considered. The ring or circle around her tumor that you describe on the MRI is due to uptake of the MRI contrast, known as contrast enhancement. This enhancement can be from tumor progression, or can represent long-term changes from patients who were treated with radiation.