link
Bookmarks
Radiation and Chemotherapy
Miral D. Jhaveri, MD; Karen L. Salzman, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
13
5
3

KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Radiation-induced injury (RII)
            • Synonyms

              • Radiation (XRT) changes, chemotherapy effects, treatment-related changes
            • Definitions

              • RII may be divided into acute (during or shortly after radiation), subacute/early delayed (typically up to 12 weeks after radiation), and late (months to years after completion of radiation)
              • Includes radiation injury (edema, arteritis), radiation necrosis, leukoencephalopathy, mineralizing microangiopathy, necrotizing leukoencephalopathy, posterior reversible encephalopathy syndrome (PRES), radiation-induced tumors

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Nolan CP et al: Neurologic complications of chemotherapy and radiation therapy. Continuum (Minneap Minn). 21(2 Neuro-oncology):429-51, 2015
                                              2. Diaz AZ et al: Radiation-associated toxicities in the treatment of high-grade gliomas. Semin Oncol. 41(4):532-40, 2014
                                              3. O'Brien BJ et al: Post-treatment imaging changes in primary brain tumors. Curr Oncol Rep. 16(8):397, 2014
                                              4. Zhang H et al: Role of magnetic resonance spectroscopy for the differentiation of recurrent glioma from radiation necrosis: a systematic review and meta-analysis. Eur J Radiol. 83(12):2181-9, 2014
                                              5. Reddy K et al: MRI patterns of T1 enhancing radiation necrosis versus tumour recurrence in high-grade gliomas. J Med Imaging Radiat Oncol. 57(3):349-55, 2013
                                              6. Shah R et al: Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics. 32(5):1343-59, 2012
                                              7. Chan KC et al: MRI of late microstructural and metabolic alterations in radiation-induced brain injuries. J Magn Reson Imaging. 29(5):1013-20, 2009
                                              8. Hackney DB: Forget the diffusion--do we need T2-weighted MR images to detect early central nervous system injury? Radiology. 250(2):303-4, 2009
                                              9. Pružincová L et al: MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay. Eur Radiol. Epub ahead of print, 2009
                                              10. Sundgren PC et al: Metabolic alterations: a biomarker for radiation-induced normal brain injury-an MR spectroscopy study. J Magn Reson Imaging. 29(2):291-7, 2009
                                              11. Sundgren PC: MR Spectroscopy in Radiation Injury. AJNR Am J Neuroradiol. Epub ahead of print, 2009
                                              12. Kang TW et al: Morphological and functional MRI, MRS, perfusion and diffusion changes after radiosurgery of brain metastasis. Eur J Radiol. Epub ahead of print, 2008
                                              13. Welzel T et al: Diffusion tensor imaging screening of radiation-induced changes in the white matter after prophylactic cranial irradiation of patients with small cell lung cancer: first results of a prospective study. AJNR Am J Neuroradiol. 29(2):379-83, 2008
                                              14. Burn S et al: Incidence of cavernoma development in children after radiotherapy for brain tumors. J Neurosurg. 106(5 Suppl):379-83, 2007
                                              15. Zeng QS et al: Multivoxel 3D proton MR spectroscopy in the distinction of recurrent glioma from radiation injury. J Neurooncol. 84(1):63-9, 2007
                                              16. Chan MS et al: MR imaging of the brain in patients cured of acute lymphoblastic leukemia--the value of gradient echo imaging. AJNR Am J Neuroradiol. 27(3):548-52, 2006
                                              17. Chan YL et al: Dynamic susceptibility contrast-enhanced perfusion MR imaging in late radiation-induced injury of the brain. Acta Neurochir Suppl. 95:173-5, 2005
                                              18. Weybright P et al: Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy. AJR Am J Roentgenol. 185(6):1471-6, 2005
                                              19. Vázquez E et al: Neuroimaging in pediatric leukemia and lymphoma: differential diagnosis. Radiographics. 22(6):1411-28, 2002
                                              20. Chong VF et al: Temporal lobe changes following radiation therapy: imaging and proton MR spectroscopic findings. Eur Radiol. 11(2):317-24, 2001
                                              21. Kamiryo T et al: Radiosurgery-induced microvascular alterations precede necrosis of the brain neuropil. Neurosurgery. 49(2):409-14; discussion 414-5, 2001
                                              22. Kumar AJ et al: Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology. 217(2):377-84, 2000
                                              23. Keime-Guibert F et al: Neurological complications of radiotherapy and chemotherapy. J Neurol. 245(11):695-708, 1998
                                              Related Anatomy
                                              Loading...
                                              Related Differential Diagnoses
                                              Loading...
                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Radiation-induced injury (RII)
                                                        • Synonyms

                                                          • Radiation (XRT) changes, chemotherapy effects, treatment-related changes
                                                        • Definitions

                                                          • RII may be divided into acute (during or shortly after radiation), subacute/early delayed (typically up to 12 weeks after radiation), and late (months to years after completion of radiation)
                                                          • Includes radiation injury (edema, arteritis), radiation necrosis, leukoencephalopathy, mineralizing microangiopathy, necrotizing leukoencephalopathy, posterior reversible encephalopathy syndrome (PRES), radiation-induced tumors

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Angiographic Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Nolan CP et al: Neurologic complications of chemotherapy and radiation therapy. Continuum (Minneap Minn). 21(2 Neuro-oncology):429-51, 2015
                                                                                          2. Diaz AZ et al: Radiation-associated toxicities in the treatment of high-grade gliomas. Semin Oncol. 41(4):532-40, 2014
                                                                                          3. O'Brien BJ et al: Post-treatment imaging changes in primary brain tumors. Curr Oncol Rep. 16(8):397, 2014
                                                                                          4. Zhang H et al: Role of magnetic resonance spectroscopy for the differentiation of recurrent glioma from radiation necrosis: a systematic review and meta-analysis. Eur J Radiol. 83(12):2181-9, 2014
                                                                                          5. Reddy K et al: MRI patterns of T1 enhancing radiation necrosis versus tumour recurrence in high-grade gliomas. J Med Imaging Radiat Oncol. 57(3):349-55, 2013
                                                                                          6. Shah R et al: Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics. 32(5):1343-59, 2012
                                                                                          7. Chan KC et al: MRI of late microstructural and metabolic alterations in radiation-induced brain injuries. J Magn Reson Imaging. 29(5):1013-20, 2009
                                                                                          8. Hackney DB: Forget the diffusion--do we need T2-weighted MR images to detect early central nervous system injury? Radiology. 250(2):303-4, 2009
                                                                                          9. Pružincová L et al: MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay. Eur Radiol. Epub ahead of print, 2009
                                                                                          10. Sundgren PC et al: Metabolic alterations: a biomarker for radiation-induced normal brain injury-an MR spectroscopy study. J Magn Reson Imaging. 29(2):291-7, 2009
                                                                                          11. Sundgren PC: MR Spectroscopy in Radiation Injury. AJNR Am J Neuroradiol. Epub ahead of print, 2009
                                                                                          12. Kang TW et al: Morphological and functional MRI, MRS, perfusion and diffusion changes after radiosurgery of brain metastasis. Eur J Radiol. Epub ahead of print, 2008
                                                                                          13. Welzel T et al: Diffusion tensor imaging screening of radiation-induced changes in the white matter after prophylactic cranial irradiation of patients with small cell lung cancer: first results of a prospective study. AJNR Am J Neuroradiol. 29(2):379-83, 2008
                                                                                          14. Burn S et al: Incidence of cavernoma development in children after radiotherapy for brain tumors. J Neurosurg. 106(5 Suppl):379-83, 2007
                                                                                          15. Zeng QS et al: Multivoxel 3D proton MR spectroscopy in the distinction of recurrent glioma from radiation injury. J Neurooncol. 84(1):63-9, 2007
                                                                                          16. Chan MS et al: MR imaging of the brain in patients cured of acute lymphoblastic leukemia--the value of gradient echo imaging. AJNR Am J Neuroradiol. 27(3):548-52, 2006
                                                                                          17. Chan YL et al: Dynamic susceptibility contrast-enhanced perfusion MR imaging in late radiation-induced injury of the brain. Acta Neurochir Suppl. 95:173-5, 2005
                                                                                          18. Weybright P et al: Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy. AJR Am J Roentgenol. 185(6):1471-6, 2005
                                                                                          19. Vázquez E et al: Neuroimaging in pediatric leukemia and lymphoma: differential diagnosis. Radiographics. 22(6):1411-28, 2002
                                                                                          20. Chong VF et al: Temporal lobe changes following radiation therapy: imaging and proton MR spectroscopic findings. Eur Radiol. 11(2):317-24, 2001
                                                                                          21. Kamiryo T et al: Radiosurgery-induced microvascular alterations precede necrosis of the brain neuropil. Neurosurgery. 49(2):409-14; discussion 414-5, 2001
                                                                                          22. Kumar AJ et al: Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology. 217(2):377-84, 2000
                                                                                          23. Keime-Guibert F et al: Neurological complications of radiotherapy and chemotherapy. J Neurol. 245(11):695-708, 1998