Malignant Gliomas: MR Imaging Spectrum of Radiation Therapy- and Chemotherapy-induced Necrosis of the Brain after Treatment

Top Cited Papers
Publisher Website
Google Scholar
Abstract
To describe both the common and less frequently encountered magnetic resonance (MR) imaging features of radiation therapy- and chemotherapy-induced brain injury, with particular emphasis on radiation necrosis. A cohort of 148 adult patients underwent surgical resection of malignant brain (glial) tumors and were subsequently entered into a research protocol that consisted of accelerated radiation therapy with carboplatin followed by chemotherapy with procarbazine, lomustine, and vincristine. Patients typically underwent sequential MR imaging at 6-8-week intervals during the 1st year and at 3-6-month intervals during subsequent years. In all patients, histopathologic confirmation of lesion composition was performed by board-certified neuropathologists. The patients exhibited different types of MR imaging-detected abnormalities of the brain: pure radiation necrosis in 20 patients, a mixture of predominantly radiation necrosis with limited recurrent and/or residual tumor (less than 20% of resected tissue) in 16 patients, radiation necrosis of the cranial nerves and/or their pathways in two patients, radiation-induced enhancement of the white matter in 52 patients, and radiation-induced enhancement of the cortex in nine patients. The frequent diagnostic dilemma of recurrent neoplasm versus radiation necrosis is addressed in this study through a description of the varying spatial and temporal patterns of radiation necrosis at MR imaging.

This publication has 24 references indexed in Scilit: