Evolution of Radiation-induced Brain Injury: MR Imaging-based Study
Evolution of Radiation-induced Brain Injury: MR Imaging-based Study
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DOI：
10.1148/radiol.09090428
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发表时间：
2010-01-01
期刊：
影响因子：
19.7
通讯作者：
Ahuja, Anil T.
中科院分区：
文献类型：
--
作者：
Wang, Yi-Xiang J.;King, Ann D.;Ahuja, Anil T.
目的：评估鼻咽癌患者的颞叶，以更好地了解不受潜在肿瘤影响的脑延迟性辐射损伤。材料和方法：回顾性分析患者资料，经当地伦理委员会批准。知情同意被放弃。分析鼻咽癌放射治疗后颞叶损伤（TLI）患者的磁共振成像结果。评估白质病变（WMLs）、造影剂增强病变和囊肿的外观和随时间的变化。间隔时间比较采用Mann-Whitney U检验，TLI变化规律比较采用chi(2)和Fisher精确检验。结果：研究组124例患者（男95例，女29例，平均年龄51.4岁），其中颞叶损伤192例；在103例颞叶损伤患者中，62例接受了至少1次（1 - 5次）mri随访。共发现损伤的颞叶332个。WMLs、增强病变和囊肿分别出现在332例（100%）、274例（82.5%）和42例（12.7%）研究中。所有大于2cm的增强病灶均显示坏死，大于3cm的形成边缘增强坏死肿块。白质损伤是唯一单独发生的病变，增强病变总是伴白质损伤，囊肿总是伴白质损伤和增强病变。囊肿的发现明显晚于白质损伤和增强病变的发现（P < 0.01）。96个WMLs中有27个（28%）、94个增强病灶中有37个（39%）、15个囊肿中有1个（7%）出现消退或消退。结论：放射引起的TLI并不总是一个不可逆的进行性过程，而是一个可以在MR成像上消退或消退的过程。在辐射损伤的演变过程中，首先发现脑损伤，其次是增强的病变，随着大小的增加，坏死的趋势越来越大。囊肿是最不常见的表现，出现在TLI的晚期。(c) rsna， 2009年
Purpose: To evaluate the temporal lobes in patients previously treated for nasopharyngeal carcinoma to provide a better understanding of delayed radiation-induced injury in the brain unaffected by the underlying tumor.Materials and Methods: Retrospective analysis of the patient data was approved by the local ethics committee. Informed consent was waived. Magnetic resonance (MR) imaging results in patients with temporal lobe injury (TLI) after receiving radiation for nasopharyngeal carcinoma were analyzed. The appearance and change over time of white matter lesions (WMLs), contrast material-enhanced lesions, and cysts were assessed. The Mann-Whitney U test was used to compare interval time, and the chi(2) and Fisher exact tests were used to compare the pattern of TLI changes.Results: The study group was 124 patients ( 95 men, 29 women; mean age, 51.4 years) with 192 injured temporal lobes; 62 of these patients with 103 injured temporal lobes underwent follow-up MR imaging at least once (range, one to five examinations). A total of 332 injured temporal lobes were revealed. WMLs, contrast-enhanced lesions, and cysts were present on 332 (100%), 274 (82.5%), and 42 (12.7%) studies, respectively. All contrast-enhanced lesions more than 2 cm in size showed necrosis, and those 3 cm or greater formed a rim-enhanced necrotic mass. WMLs were the only lesion to occur alone, contrast-enhanced lesions were always accompanied by WMLs, and cysts were always accompanied by WMLs and contrast-enhanced lesions. Detection of cysts was significantly later than detection of WMLs and contrast-enhanced lesions (P < .01). Regression or resolution was found in 27 (28%) of 96 WMLs, 37 (39%) of 94 contrast-enhanced lesions, and one (7%) of 15 cysts.Conclusion: TLI from radiation is not always an irreversible and progressive process but is one that can regress or resolve at MR imaging. In the evolution of radiation injury, WMLs are seen first and are followed by contrast-enhanced lesions, which have an increasing tendency to become necrotic with increasing size. Cysts are the least frequent manifestation and arise in the late stage of TLI. (C) RSNA, 2009