Large intracranial vessel occlusive vasculopathy after radiation therapy in children: Clinical features and usefulness of magnetic resonance imaging
Large intracranial vessel occlusive vasculopathy after radiation therapy in children: Clinical features and usefulness of magnetic resonance imaging
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DOI：
10.1016/s0360-3016(97)82497-2
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发表时间：
1997-05-01
影响因子：
7
通讯作者：
Matsubara, S
中科院分区：
文献类型：
--
作者：
Omura, M;Aida, N;Matsubara, S
目的：探讨颅内大血管闭塞性血管病(血管病)与放射治疗的关系，探讨磁共振成像(MR)在脑血管病变诊断和筛查中的临床价值。方法：对32例接受过Willis环和大脑大动脉等部位放射治疗的儿童患者的病历和系列MR影像资料进行回顾性分析。所有儿童在接受放射治疗后(1.3-14岁)，定期在神奈川儿童医学中心接受一年以上的随访神经学评估和磁共振成像检查。结果：32例患者中有6例在放射治疗后2~13年出现血管病变，其中3例有短暂性脑缺血发作(TIA)，3例无TIA表现，6例MRI均可发现脑主要动脉狭窄闭塞改变，其余26例未见，TIA时MR表现为狭窄闭塞改变，在不可逆脑梗塞发生前，3例无TIA表现的脑干动脉狭窄闭塞，6例患者的脑血管环和大脑主要动脉的平均照射剂量明显高于其余26例无后遗症的患者(61Gyvs，50Gyp<；0.05)。6例患者放疗时平均年龄较低，但差异无统计学意义。结论：放疗后血管病变的发生率与放疗剂量、放疗年龄有较大相关性，MR检查有助于血管病变的诊断评价，对TIA患者血管病变的筛查也有一定作用，有助于预防神经后遗症的发生。(C)1997年爱思唯尔科学公司。
Purpose: To assess the relationship between large intracranial vessel occlusive vasculopathy (vasculopathy) and radiation therapy, and to clarify the clinical efficacy of magnetic resonance (MR) imaging in the diagnosis and screening of the vasculopathy.Methods and Materials: We retrospectively evaluated the medical records and serial MR images for 32 pediatric patients, in whom radiation therapy had been given to fields including the circle of Willis and major cerebral arteries. All children had periodically undergone follow-up neurologic assessment and MR imaging examinations at Kanagawa Children's Medical Center for more than one year after radiation therapy (range 1.3-14 years). Patients who had not remained free of tumor progression up to the time of final evaluation were excluded.Results: Vasculopathy developed in 6 of 32 patients 2-13 years after radiation therapy, Three of them presented with transient ischemic attacks (TIA) and the other three showed infarctions without preceding TIA, Steno-occlusive changes of major cerebral arteries were identified by MR imaging in all six patients, but not obtained in the remaining 26 patients, In the patients with TIA, MR imaging demonstrated steno-occlusive changes at the time of TIA, before irreversible infarction, They have been doing well subsequent to encephaloduroarteriosynangiosis, In the three patients who presented infarction without preceding TIA, MR imaging did not demonstrate the vascular change before the onset of infarction, and two of them developed neurologic deficits, The mean exposure dose for the circle of Willis and major cerebral arteries in these six patients was significantly higher than that in the remaining 26 patients without this sequela (61Gy vs, 50Gy, p < 0.05). The mean age at radiation therapy of the six patients was lower, but the difference was not significant.Conclusion: The incidence of vasculopathy after radiation therapy has a considerable correlation with radiation dose and age at radiation therapy, MR examination is useful for the diagnostic evaluation of vasculopathy, and it is also effective in screening for vasculopathy in patients with TIA, and may be helpful in the prevention of neurologic sequela. (C) 1997 Elsevier Science Inc.