Long-term changes induced, by high dose irradiation of the head and neck region: Imaging findings
Long-term changes induced, by high dose irradiation of the head and neck region: Imaging findings
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DOI：
10.1148/radiographics.17.1.9017796
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发表时间：
1997-01-01
期刊：
影响因子：
5.5
通讯作者：
Terrier, F
中科院分区：
文献类型：
--
作者：
Becker, M;Schroth, G;Terrier, F
高剂量照射是头颈部肿瘤的有效治疗方法，放射引起的并发症并不常见，但可能会在治疗后数月或数年导致慢性、进行性症状。在 5 年期间成功接受头颈部肿瘤高剂量照射的 1,950 名患者中，有 19 名 (1%) 患者通过影像学记录了延迟的放射引起的变化，这些变化可分为软组织、骨和软骨坏死；纤维化导致功能障碍；动脉病;中枢神经系统反应、迟发性脊髓病和颅神经麻痹；和脑膜瘤的发展。辐射引起的软组织、骨和软骨坏死的放射学特征包括受累区域附近的炎症肿胀；深层含气溃疡；相关软骨出现硬化；坏死骨或软骨碎裂和脱落；以及脓肿和瘘管的形成。咀嚼肌纤维化表现为 T2 加权图像上信号强度弥漫性增加以及对比后 T1 加权图像上增强的区域。放射性动脉病可能表现为闭塞、闭塞性硬化或粥样斑块、局部附壁血栓、动脉瘤或罕见的自发性破裂。在中枢神经系统反应中，影像学表现包括白质脱髓鞘病灶、局灶性放射性坏死和严重脑萎缩。放射诱发的脑膜瘤在计算机断层扫描、磁共振成像和核磁共振成像中表现出与非放射诱发的脑膜瘤相同的影像学特征。血管造影，尽管后续检查可能会揭示其更具攻击性的生物学行为，但了解辐射引起的变化的放射学外观可能会防止误解并促进治疗。
High-dose irradiation is an effective treatment for tumors in the head and neck, Radiation-induced complications are uncommon but may result in chronic, progressive symptoms months or years after therapy, In 19 (1%) of 1,950 patients who underwent successful high-dose irradiation of head and neck tumors over a 5-year period, delayed radiation-induced changes were documented with imaging, These changes can be categorized as soft-tissue, bone, and cartilage necrosis; fibrosis leading to functional disorders; arteriopathy; central nervous system reactions, delayed myelopathy, and cranial nerve palsies; and the development of meningiomas. Radiologic features of radiation-induced soft-tissue, bone, and cartilage necrosis include inflammatory swelling adjacent to the area of involvement; deep gas-containing ulcerations; sclerotic appearance of the involved cartilages; fragmentation and sloughing of necrotic bone or cartilage; and abscess and fistula formation. Masticator muscle fibrosis appears as an area of diffusely increased signal intensity on T2-weighted images and of enhancement on postcontrast T1-weighted images. Radiation arteriopathy may manifest as occlusion, subocclusive sclerotic or atheromatous plaque, localized mural thrombus, aneurysm, or, rarely, spontaneous rupture, In central nervous system reactions, imaging findings include demyelination foci in the white matter, focal radiation necrosis, and severe brain atrophy, Radiation-induced meningiomas display the same imaging features as non-radiation-induced meningiomas at computed tomography, magnetic resonance imaging, and angiography, although follow-up examinations may reveal their more aggressive biologic behavior, Knowledge of the radiologic appearance of radiation-induced changes may prevent misinterpretations and facilitate treatment.