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Postradiation Evaluation
Abdul-Rahman Abualruz, MD; Ashley F. Blurton, MD, MS; Paige Bennett, MD
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KEY FACTS

  • Imaging

    • Clinical Issues

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Radiation necrosis following radiation treatment common and resembles tumor recurrence on imaging
          • Differentiating between tumor recurrence and radiation necrosis fundamental challenge that affects patient care
          • Posttreatment radiation injury can occur following
            • Radiation therapy (RT) for primary brain tumors
            • Stereotactic radiation therapy for brain metastasis [including stereotactic radiosurgery (SRS)]
            • Radiation therapy for H&N malignancy or intracranial extraaxial tumor
          • Types
            • Acute: During or immediately after radiation
            • Early delayed: Up to 6 months
            • Late: 6 months or later

        IMAGING

        • Nuclear Medicine Findings

          • CT Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  • Gross Pathologic & Surgical Features

                    CLINICAL ISSUES

                    • Presentation

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          • Image Interpretation Pearls

                            Selected References

                            1. Tsitsia V et al: Multimodality-multiparametric brain tumors evaluation. Hell J Nucl Med. 20(1):57-61, 2017
                            2. Torrens M et al: Although non-diagnostic between necrosis and recurrence, FDG PET/CT assists management of brain tumours after radiosurgery. In Vivo. 30(4):513-20, 2016
                            3. Miyatake S et al: Pathophysiology, diagnosis, and treatment of radiation necrosis in the brain. Neurol Med Chir (Tokyo). 55(1):50-9, 2015
                            4. Shah R et al: Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics. 32(5):1343-59, 2012
                            5. Chao ST et al: The sensitivity and specificity of FDG PET in distinguishing recurrent brain tumor from radionecrosis in patients treated with stereotactic radiosurgery. Int J Cancer. 96(3):191-7, 2001
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Imaging

                              • Clinical Issues

                                • Diagnostic Checklist

                                  TERMINOLOGY

                                  • Definitions

                                    • Radiation necrosis following radiation treatment common and resembles tumor recurrence on imaging
                                    • Differentiating between tumor recurrence and radiation necrosis fundamental challenge that affects patient care
                                    • Posttreatment radiation injury can occur following
                                      • Radiation therapy (RT) for primary brain tumors
                                      • Stereotactic radiation therapy for brain metastasis [including stereotactic radiosurgery (SRS)]
                                      • Radiation therapy for H&N malignancy or intracranial extraaxial tumor
                                    • Types
                                      • Acute: During or immediately after radiation
                                      • Early delayed: Up to 6 months
                                      • Late: 6 months or later

                                  IMAGING

                                  • Nuclear Medicine Findings

                                    • CT Findings

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • General Features

                                            • Gross Pathologic & Surgical Features

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Treatment

                                                  DIAGNOSTIC CHECKLIST

                                                  • Consider

                                                    • Image Interpretation Pearls

                                                      Selected References

                                                      1. Tsitsia V et al: Multimodality-multiparametric brain tumors evaluation. Hell J Nucl Med. 20(1):57-61, 2017
                                                      2. Torrens M et al: Although non-diagnostic between necrosis and recurrence, FDG PET/CT assists management of brain tumours after radiosurgery. In Vivo. 30(4):513-20, 2016
                                                      3. Miyatake S et al: Pathophysiology, diagnosis, and treatment of radiation necrosis in the brain. Neurol Med Chir (Tokyo). 55(1):50-9, 2015
                                                      4. Shah R et al: Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics. 32(5):1343-59, 2012
                                                      5. Chao ST et al: The sensitivity and specificity of FDG PET in distinguishing recurrent brain tumor from radionecrosis in patients treated with stereotactic radiosurgery. Int J Cancer. 96(3):191-7, 2001