Top

Published in:

01-11-2009 | Neuro

MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay

Authors: Ľ. Pružincová, J. Šteňo, M. Srbecký, P. Kalina, B. Rychlý, E. Bolješíková, M. Chorváth, M. Novotný, V. Pročka, I. Makaiová, V. Belan

Published in: European Radiology | Issue 11/2009

Abstract

Radiation to the brain and adjuvant chemotherapy may produce late delayed changes from several months to years after treatment of intracranial malignancies with a reported prevalence of 5–24%. The pattern of treatment-related injury may vary from diffuse periventricular white matter lesions to focal or multifocal lesions. Differentiation of treatment-related injury from tumor progression/recurrence may be difficult with conventional MR imaging (MRI). With both disease processes, the characteristic but nonspecific imaging features are vasogenic edema, contrast enhancement, and mass effect. This pictorial essay presents MRI spectra of late therapy-induced injuries in the brain with a particular emphasis on radiation necrosis, the most common and severe form. Novel MRI techniques, such as diffusion-weighted imaging (DWI), proton MR spectroscopy (MRS), and perfusion MRI, improve the possibilities of better characterization of treatment-related changes. Advanced MRI techniques allow for the assessment of metabolism and physiology and may increase specificity for therapy-induced changes.

Sheline GE, Wara WM, Smith V (1980) Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 6:1215–1228PubMed

Ruben JD, Dally M, Bailey M, Smith R, McLean CA et al (2006) Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiation Oncology Biol Phys 65:499–508

Johannesen TB, Lien HH, Hole KH, Lote K (2003) Radiological and clinical assessment of long-term brain tumour survivors after radiotherapy. Radiother Oncol 69:169–176CrossRefPubMed

Marks JE, Baglan RJ, Prassad SC, Blank WF (1981) Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys 7:243–252PubMed

Perry A, Schmidt RE (2006) Cancer therapy-associated CNS neuropathology: an update and review of the literature. Acta Neuropathol 111:197–212CrossRefPubMed

Langleben DD, Segall GM (2000) PET in differentiation of recurrent brain tumor from radiation injury. J Nucl Med 41:1861–1867PubMed

Spaeth N, Wyss MT, Weber B, Scheidegger S et al (2004) Uptake of ¹⁸F-fluorocholine, ¹⁸F-fluoroethyl-L-tyrosine, and ¹⁸F-FDG in acute cerebral radiation injury in the rat: implications for separation of radiation necrosis from tumor recurrence. J Nucl Med 45:1931–1938PubMed

Sugahara T, Korogi Y, Tomiguchi S, Shigematsu Y, Ikushima I et al (2000) Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue. AJNR Am J Neuroradiol 21:901–909PubMed

Morris JG, Grattan-Smith P, Panegyres PK, O’Neill P, Soo YS, Langlands AO (1994) Delayed cerebral radiation necrosis. Q J Med 87:119–129PubMed

10.

Burger PC, Mahley MS Jr, Dudka L, Vogel FS (1979) The morphologic effects of radiation administered therapeutically for intracranial gliomas: a postmortem study of 25 cases. Cancer 44:1256–1272CrossRefPubMed

11.

Kumar AJ, Leeds NE, Fuller GN, Tassel PV, Maor MH et al (2000) Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology 217:377–384PubMed

12.

Schultheiss TE, Kun LE, Ang KK, Stephens LC (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31:1093–1112PubMed

13.

Burger PC, Boyko OB (1991) The pathology of central nervous system radiation injury. In: Gutin PH, Leibel SA, Sheline GE (eds) Radiation injury to the nervous system. Raven, New York, pp 191–208

14.

Burger PC, Scheithauer BW (2007) Tumors of the central nervous system. American Registry of Pathology, Washington

15.

Ironside JW, Moss TH, Louis DN, Lowe JS, Weller RO (2002) Diagnostic pathology of nervous system tumours. Churchill Livingstone, New York

16.

Belka C, Budach W, Kortmann RD, Bamberg M (2001) Radiation induced CNS toxicity-molecular and cellular mechanisms. Br J Cancer 85:1233–1239CrossRefPubMed

17.

Lampert PW, Davis RL (1964) Delayed effects of radiation on the human central nervous system: “early” and “late” delayed reactions. Neurology 14:912–917PubMed

18.

Sugahara T, Korogi Y, Kochi M, Ikushima I, Shigematu Y, Hirai T et al (1999) Usefulness of diffusion-weighted MRI with echoplanar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging 9:53–60CrossRefPubMed

19.

Asao CH, Korogi Y, Kitajima M, Hirai T, Baba Y et al (2005) Diffusion-weighted imaging of radiation-induced brain injury for differentiation from tumor recurrence. AJNR Am J Neuroradiol 26:1455–1460PubMed

20.

Kono K, Inoue Y, Nakayama K et al (2001) The role of diffusion-weighted imaging in patients with brain tumors. AJNR Am J Neuroradiol 22:1081–1088PubMed

21.

Hayashida Y, Hirai T, Morishita S, Kitajima M, Murakami R et al (2006) Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. AJNR Am J Neuroradiol 27:1419–1425PubMed

22.

Hein PA, Eskey CJ, Dunn JF, Hug EB (2004) Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: tumor recurrence versus radiation injury. AJNR Am J Neuroradiol 25:201–209PubMed

23.

Zeng QS, Li CF, Liu H, Zhen JH, Feng DC (2007) Distinction between recurrent glioma and radiation injury using magnetic resonance spectroscopy in combination with diffusion-weighted imaging. Int J Radiation Oncology Biol Phys 68:151–158

24.

Tung GA, Evangelista P, Rogg JM, Duncan JA (2001) Diffusion-weighted MR imaging of rim-enhancing brain masses: is markedly decreased water diffusion specific for brain abscess? AJR Am J Roentgenol 177:709–712PubMed

25.

Le Bihan D, Douek P, Argyropoulou M (1993) Diffusion and perfusion magnetic resonance imaging in brain tumors. Top Magn Reson Imaging 5:25–31CrossRefPubMed

26.

Moritani T, Ekholm S, Westesson P-L (2004) Diffusion-weighted MR imaging of the brain. Springer Verlag, Berlin Heidelberg New York

27.

Ebisu T, Tanaka C, Umeda M et al (1996) Discrimination of brain abscess from necrotic or cystic tumors by echo planar imaging. Magn Reson Imaging 14:1113–1116CrossRefPubMed

28.

Fredman DP, Goldman HW, Flanders AE (1997) MR imaging of stereotaxic palidotomy and thalamotomy. AJR Am J Roentgenol 169:894–896

29.

Tien RD, Flesberg GJ, Friedman H, Brown M, MacFall J (1994) MR imaging of high-grade cerebral gliomas: value of diffusion-weighted echoplanar pulse sequences. AJR Am J Roentgenol 162:671–677PubMed

30.

Hakyemez B, Erdogan C, Yildirim N, Parlak M (2005) Glioblastoma multiforme with atypical diffusion-weighted MR findings. Br J Radiol 78:989–992CrossRefPubMed

31.

Aronen HJ, Gazit IE, Louis DN et al (1994) Cerebral blood volume maps of gliomas: comparison with tumor grade and histologic findings. Radiology 191:41–51PubMed

32.

Covarrubias DJ, Rosen BR, Lev MH (2004) Dynamic magnetic resonance perfusion imaging of brain tumors. Oncologist 9:528–537CrossRefPubMed

33.

Cha S, Knopp EA, Johnson G, Wetzel SG, Litt AW, Zagzag D (2002) Intracranial mass lesions: dynamic contrast-enhanced susceptibility-weighted echo-planar perfusion MR imaging. Radiology 223:11–29CrossRefPubMed

34.

Cotton F, Hermier M (2006) The advantage of high relaxivity contrast agents in brain perfusion. Eur Radio1 Suppl 16(Suppl 7):M 16–M 26

35.

Wong JC, Provenzale JM, Petrella JR (2000) Perfusion MR imaging of brain neoplasms. AJR 174:1147–1157PubMed

36.

Sugahara T, Korogi Y, Kochi M et al (1998) Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. AJR Am J Roentgenol 171:1479–1486PubMed

37.

Aksoy FG, Lev MH (2000) Dynamic contrast- enhanced brain perfusion imaging: technique and clinical applications. Semin Ultrasound CT MR 21:462–477CrossRefPubMed

38.

Sorensen AG, Reimer P (2000) Cerebral MR perfusion imaging. Thieme, Stuttgart

39.

Kimura T, Sako K, Tohyama Y, Aizawa S, Yoshida H et al (2003) Diagnosis and treatment of progressive space-occupying radiation necrosis following stereotactic radiosurgery for brain metastasis: value of proton magnetic resonance spectroscopy. Acta Neurochir (Wien) 145:557–564CrossRef

40.

Ge Y, Law M, Johnson G et al (2005) Dynamic susceptibility contrast perfusion MR imaging of multiple sclerosis lesions: characterizing hemodynamic impairment and inflammatory activity. AJNR Am J Neuroradiol 26:1539–1547PubMed

41.

Chong VF-H, Rumpel H, Fan Y-F, Mukherji SK (2001) Temporal lobe changes following radiation therapy: imaging and proton MR spectroscopic findings. Eur Radiol 11:317–324CrossRefPubMed

42.

Edelman RR, Hesselink JR, Zlatkin MB, Crues JV (2006) Clinical magnetic resonance imaging. Saunders, Philadelphia

43.

Hollingworth W, Medina LS, Lenkinski RE, Shibata DK, Bernal B et al (2006) A systematic literature review of magnetic resonance spectroscopy for the characterization of brain tumors. AJNR 27:1404–1411PubMed

44.

Lichy MP, Plathow CH, Schulz-Ertner D, Kauczor HU, Schlemmer H-P (2005) Follow-up gliomas after radiotherapy: ¹H MR spectroscopic imaging for increasing diagnostic accuracy. Neuroradiology 47:826–834CrossRefPubMed

45.

Kimura T, Sako K, Tanaka K, Gotoh T, Yoshida H et al (2004) Evaluation of the response of metastatic brain tumors to stereotactic radiosurgery by proton magnetic resonance spectroscopy, ²⁰¹TICI single-photon emission computerized tomography, and gadolinium-enhanced magnetic resonance imaging. J Neurosurg 100:835–841CrossRefPubMed

46.

Lichy MP, Henze M, Plathow C et al (2004) Metabolic imaging to follow stereotactic radiation of gliomas—the role of ¹H MR spectroscopy in comparison to FDG-PET and IMT-SPECT. Rofo 176:1114–1121PubMed

47.

Ando K, Ishikura R, Nagami et al (2004) Usefulness of Cho/Cr ratio in proton MR spectroscopy for differentiating residual/recurrent glioma from non-neoplastic lesions. Nippon Igaku Hoshasen Gakkai Zasshi 64:121–126PubMed

48.

Schlemmer HP, Bachert P, Herfarth K, Zuna I, Debus J et al (2001) Proton MR spectroscopic evaluation of suspicious brain lesions after stereotactic readiotherapy. AJNR Am J Neuroradiol 22:1316–1324PubMed

49.

Sundgren PC, Mukherji SK (2004) MRS applications in oncology. In: Imaging Economics. http://www.imagingeconomics.com/issues/articles/2004-09_06.asp. Accessed 1 Aug 2008

50.

Plotkin M, Eisenacher J, Brunh H et al (2004) 123I-IMT SPECT and 1H MR-spectroscopy at 3.0 T in the differential diagnosis of recurrent or residual gliomas: a comparative study. Neurooncol 70:49–58CrossRef

51.

Kimura T, Sako K, Tanaka K, Gotoh T, Tanaka T (2001) In vivo single-voxel proton MR spectroscopy in brain lesions with ring-like enhancement. NMR in Biomed 14:339–349CrossRef

52.

Traber F, Block W, Flacke S et al (2002) 1H MR spectroscopy of brain tumors in the course of radiation therapy: use of fast spectroscopic imaging and single-voxel spectroscopy for diagnosing recurrence. Rofo 174:33–42PubMed

53.

Rabinov JD, Lee PL, Barker FG, Louis DN, Harsh GR et al (2002) In vivo 3-T MR spectroscopy in the distinction of recurrent glioma versus radiation effects: initial experience. Radiology 225:871–879CrossRefPubMed

54.

Rock JP, Scarpace L, Hearshen D, Gutierrez J et al (2004) Associations among magnetic resonance spectroscopy, apparent diffusion coefficients, and image guided histopathology with special attention to radiation necrosis. Neurosurgery 54:1111–1119CrossRefPubMed

Title: MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay
Authors: Ľ. Pružincová
J. Šteňo
M. Srbecký
P. Kalina
B. Rychlý
E. Bolješíková
M. Chorváth
M. Novotný
V. Pročka
I. Makaiová
V. Belan
Publication date: 01-11-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 11/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-009-1449-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2009

An incidental mass seen at CT coronary angiography (2009: 11a)

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms

Whole-organ perfusion of the pancreas using dynamic volume CT in patients with primary pancreas carcinoma: acquisition technique, post-processing and initial results

Parametric exploration of the liver by magnetic resonance methods

Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients

Abdominal pain in a young woman (2009: 8b)