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Radiation Myelopathy
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Chronic progressive radiation myelitis (CPRM)
                • Delayed radiation myelopathy (DRM)
                • Radiation necrosis (RN)
              • Definitions

                • Damage of neural tissue in spinal cord following therapeutic radiation of intrinsic or adjacent neoplastic disease

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Keřkovský M et al: Diffusion Tensor Imaging in Radiation-Induced Myelopathy. J Neuroimaging. ePub, 2014
                                              2. Mahta A et al: Radiation induced myelopathy in a patient with tongue cancer: a case report. Acta Oncol. 51(3):409-11, 2012
                                              3. Rogers LR: Neurologic complications of radiation. Continuum (Minneap Minn). 18(2):343-54, 2012
                                              4. Habrand JL et al: [Normal tissue tolerance to external beam radiation therapy: spinal cord.] Cancer Radiother. 14(4-5):269-76, 2010
                                              5. Uchida K et al: Neurological improvement associated with resolution of irradiation-induced myelopathy: serial magnetic resonance imaging and positron emission tomography findings. J Neuroimaging. 19(3):274-6, 2009
                                              6. Umeda M et al: [Gadolinium enhancement of the anterior portion of the lumbosacral roots in a case of post-irradiation lumbosacral radiculopathy.] Rinsho Shinkeigaku. 45(10):758-61, 2005
                                              7. Warscotte L et al: Concurrent spinal cord and vertebral bone marrow radionecrosis 8 years after therapeutic irradiation. Neuroradiology. 44(3):245-8, 2002
                                              8. Okada S et al: Pathology of radiation myelopathy. Neuropathology. 21(4):247-65, 2001
                                              9. Calabro F et al: MRI of radiation myelitis: a report of a case treated with hyperbaric oxygen. Eur Radiol. 10(7):1079-84, 2000
                                              10. Macbeth F: Radiation myelitis and thoracic radiotherapy: evidence and anecdote. Clin Oncol (R Coll Radiol). 12(5):333-4, 2000
                                              11. Maddison P et al: Clinical and MRI discordance in a case of delayed radiation myelopathy. J Neurol Neurosurg Psychiatry. 69(4):563-4, 2000
                                              12. Nieder C et al: Radiation myelopathy: new perspective on an old problem. Radiat Oncol Investig. 7(4):193-203, 1999
                                              13. Rampling R et al: Radiation myelopathy. Curr Opin Neurol. 11(6):627-32, 1998
                                              14. Alfonso ER et al: Radiation myelopathy in over-irradiated patients: MR imaging findings. Eur Radiol. 7(3):400-4, 1997
                                              15. Koehler PJ et al: Delayed radiation myelopathy: serial MR-imaging and pathology. Clin Neurol Neurosurg. 98(2):197-201, 1996
                                              16. Wong CS et al: Radiation myelopathy following single courses of radiotherapy and retreatment. Int J Radiat Oncol Biol Phys. 30(3):575-81, 1994
                                              17. Hirota S et al: Chronological observation in early radiation myelopathy of the cervical spinal cord: gadolinium-enhanced MRI findings in two cases. Radiat Med. 11(4):154-9, 1993
                                              18. Schultheiss TE et al: Invited review: permanent radiation myelopathy. Br J Radiol. 65(777):737-53, 1992
                                              19. Bloss JD et al: Radiation myelitis: a complication of concurrent cisplatin and 5-fluorouracil chemotherapy with extended field radiotherapy for carcinoma of the uterine cervix. Gynecol Oncol. 43(3):305-8, 1991
                                              20. Dische S: Accelerated treatment and radiation myelitis. Radiother Oncol. 20(1):1-2, 1991
                                              21. Jeremic B et al: Incidence of radiation myelitis of the cervical spinal cord at doses of 5500 cGy or greater. Cancer. 68(10):2138-41, 1991
                                              22. Magrini SM et al: Neurological damage in patients irradiated twice on the spinal cord: a morphologic and electrophysiological study. Radiother Oncol. 17(3):209-18, 1990
                                              23. Marcus RB Jr et al: The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys. 19(1):3-8, 1990
                                              24. Dische S et al: Radiation myelitis and survival in the radiotherapy of lung cancer. Int J Radiat Oncol Biol Phys. 15(1):75-81, 1988
                                              25. Goldwein JW: Radiation myelopathy: a review. Med Pediatr Oncol. 15(2):89-95, 1987
                                              26. Hatlevoll R et al: Myelopathy following radiotherapy of bronchial carcinoma with large single fractions: a retrospective study. Int J Radiat Oncol Biol Phys. 9(1):41-4, 1983
                                              27. Fitzgerald RH Jr et al: Chronic radiation myelitis. Radiology. 144(3):609-12, 1982
                                              28. Worthington BS: Diffuse cord enlargement in radiation myelopathy. Clin Radiol. 30(1):117-9, 1979
                                              29. Godwin-Austen RB et al: Observations on radiation myelopathy. Brain. 98(4):557-68, 1975
                                              30. Burns RJ et al: Pathology of radiation myelopathy. J Neurol Neurosurg Psychiatry. 35(6):888-98, 1972
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Chronic progressive radiation myelitis (CPRM)
                                                            • Delayed radiation myelopathy (DRM)
                                                            • Radiation necrosis (RN)
                                                          • Definitions

                                                            • Damage of neural tissue in spinal cord following therapeutic radiation of intrinsic or adjacent neoplastic disease

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nonvascular Interventions

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Keřkovský M et al: Diffusion Tensor Imaging in Radiation-Induced Myelopathy. J Neuroimaging. ePub, 2014
                                                                                          2. Mahta A et al: Radiation induced myelopathy in a patient with tongue cancer: a case report. Acta Oncol. 51(3):409-11, 2012
                                                                                          3. Rogers LR: Neurologic complications of radiation. Continuum (Minneap Minn). 18(2):343-54, 2012
                                                                                          4. Habrand JL et al: [Normal tissue tolerance to external beam radiation therapy: spinal cord.] Cancer Radiother. 14(4-5):269-76, 2010
                                                                                          5. Uchida K et al: Neurological improvement associated with resolution of irradiation-induced myelopathy: serial magnetic resonance imaging and positron emission tomography findings. J Neuroimaging. 19(3):274-6, 2009
                                                                                          6. Umeda M et al: [Gadolinium enhancement of the anterior portion of the lumbosacral roots in a case of post-irradiation lumbosacral radiculopathy.] Rinsho Shinkeigaku. 45(10):758-61, 2005
                                                                                          7. Warscotte L et al: Concurrent spinal cord and vertebral bone marrow radionecrosis 8 years after therapeutic irradiation. Neuroradiology. 44(3):245-8, 2002
                                                                                          8. Okada S et al: Pathology of radiation myelopathy. Neuropathology. 21(4):247-65, 2001
                                                                                          9. Calabro F et al: MRI of radiation myelitis: a report of a case treated with hyperbaric oxygen. Eur Radiol. 10(7):1079-84, 2000
                                                                                          10. Macbeth F: Radiation myelitis and thoracic radiotherapy: evidence and anecdote. Clin Oncol (R Coll Radiol). 12(5):333-4, 2000
                                                                                          11. Maddison P et al: Clinical and MRI discordance in a case of delayed radiation myelopathy. J Neurol Neurosurg Psychiatry. 69(4):563-4, 2000
                                                                                          12. Nieder C et al: Radiation myelopathy: new perspective on an old problem. Radiat Oncol Investig. 7(4):193-203, 1999
                                                                                          13. Rampling R et al: Radiation myelopathy. Curr Opin Neurol. 11(6):627-32, 1998
                                                                                          14. Alfonso ER et al: Radiation myelopathy in over-irradiated patients: MR imaging findings. Eur Radiol. 7(3):400-4, 1997
                                                                                          15. Koehler PJ et al: Delayed radiation myelopathy: serial MR-imaging and pathology. Clin Neurol Neurosurg. 98(2):197-201, 1996
                                                                                          16. Wong CS et al: Radiation myelopathy following single courses of radiotherapy and retreatment. Int J Radiat Oncol Biol Phys. 30(3):575-81, 1994
                                                                                          17. Hirota S et al: Chronological observation in early radiation myelopathy of the cervical spinal cord: gadolinium-enhanced MRI findings in two cases. Radiat Med. 11(4):154-9, 1993
                                                                                          18. Schultheiss TE et al: Invited review: permanent radiation myelopathy. Br J Radiol. 65(777):737-53, 1992
                                                                                          19. Bloss JD et al: Radiation myelitis: a complication of concurrent cisplatin and 5-fluorouracil chemotherapy with extended field radiotherapy for carcinoma of the uterine cervix. Gynecol Oncol. 43(3):305-8, 1991
                                                                                          20. Dische S: Accelerated treatment and radiation myelitis. Radiother Oncol. 20(1):1-2, 1991
                                                                                          21. Jeremic B et al: Incidence of radiation myelitis of the cervical spinal cord at doses of 5500 cGy or greater. Cancer. 68(10):2138-41, 1991
                                                                                          22. Magrini SM et al: Neurological damage in patients irradiated twice on the spinal cord: a morphologic and electrophysiological study. Radiother Oncol. 17(3):209-18, 1990
                                                                                          23. Marcus RB Jr et al: The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys. 19(1):3-8, 1990
                                                                                          24. Dische S et al: Radiation myelitis and survival in the radiotherapy of lung cancer. Int J Radiat Oncol Biol Phys. 15(1):75-81, 1988
                                                                                          25. Goldwein JW: Radiation myelopathy: a review. Med Pediatr Oncol. 15(2):89-95, 1987
                                                                                          26. Hatlevoll R et al: Myelopathy following radiotherapy of bronchial carcinoma with large single fractions: a retrospective study. Int J Radiat Oncol Biol Phys. 9(1):41-4, 1983
                                                                                          27. Fitzgerald RH Jr et al: Chronic radiation myelitis. Radiology. 144(3):609-12, 1982
                                                                                          28. Worthington BS: Diffuse cord enlargement in radiation myelopathy. Clin Radiol. 30(1):117-9, 1979
                                                                                          29. Godwin-Austen RB et al: Observations on radiation myelopathy. Brain. 98(4):557-68, 1975
                                                                                          30. Burns RJ et al: Pathology of radiation myelopathy. J Neurol Neurosurg Psychiatry. 35(6):888-98, 1972