Comparative imaging study in radiation injuries following radiotherapy for nasopharyngeal carcinoma / 中华放射学杂志

ABSTRACT

Objective To evaluate the characteristics of CT, MRI, PET and histopathology of brain radiation injuries following radiotherapy for nasopharyngeal carcinoma. Methods We reviewed the imaging records of 71 patients with brain radiation injuries following radiotherapy for nasopharyngeal carcinoma examined over a 10 year period. Results The radiation injury lesions occurred in the temporal lobes, brain stems or cerebella. Their CT appears were homogeneous or heterogeneous density. If the lesions situated in temporal lobes, they presented as "finger like" hypointensity. Twenty three patients(29 lesions) undenwent contrast enhanced CT scan, 86.2 percent(25/29)of the lesions showed no enhancement. MRI demonstrated prolonged T 1 and T 2 relaxation time of the injured tissue, they might showed homogeneous or heterogeneous signal intensity. MR enhanced T 1WI were performed in 20 cases(29 lesions),and 65.5 percent(19/29)of the lesions presented "Flower lace" enhancement. Two patients were carried on PET scan. One patient′s PET appearance is similar to the CT or MRI finding. Resections and histopathologic observations of temporal lobes′ lesions were performed on 3 cases, which showed cerebral necrosis. Conclusion (1) MRI plain or contrast enhanced scan is more sensitive than that of CT or PET. (2)The heterogeneous signal intensity on T 1WI and T 2WI represent necrosis,and all are located in the radiation field. (3)"Flower lace" enhancement on contrast MRI is the characteristic of brain radionecrosis. (4)PET may serve as a complementarity in the diagnosis of radiation induced injuries.