commentary

Commentary The images presented here drive home the idea that a nonenhancing brain mass could be a metastasis if a patient's primary malignancy has been treated with an antiangiogenesis agent. It is important to be mindful of this because development of a new brain metastasis may necessitate a change in treatment of the primary malignancy, in addition to surgical resection or radiation of the brain metastasis. Bevacizumab is also being increasingly studied and used for gliomas (as part of a drug combination) and radiation necrosis (as a single agent). This case demonstrates a change in contrast enhancement without a change in tumor biology, to borrow the authors' phrase, which might occur in those settings as well. Komal Shah, MD Division of Diagnostic Imaging UT MD Anderson Cancer Center Houston, TX 77054, USA 653 M.S. Mathews et al. / Surgical Neurology 70 (2008) 649–653

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Commentary

The images presented here drive home the idea that anonenhancing brain mass could be a metastasis if apatient's primary malignancy has been treated with anantiangiogenesis agent. It is important to be mindful of thisbecause development of a new brain metastasis maynecessitate a change in treatment of the primary malig-nancy, in addition to surgical resection or radiation of thebrain metastasis.

Bevacizumab is also being increasingly studied and usedfor gliomas (as part of a drug combination) and radiationnecrosis (as a single agent). This case demonstrates a changein contrast enhancement without a change in tumor biology,to borrow the authors' phrase, which might occur in thosesettings as well.

Komal Shah, MDDivision of Diagnostic Imaging

UT MD Anderson Cancer CenterHouston, TX 77054, USA

653M.S. Mathews et al. / Surgical Neurology 70 (2008) 649–653

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