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Journal of Neuroradiology
Vol 29, N° HS 1  - août 2002
pp. 215-218
Doi : JNR-08-2002-29-HS-1-0150-9861-101019-EVN44385
MR imaging spectrum of radiation therapy- andchemotherapy-induced necrosis of the brain after treatmentof malignant gliomas
A.J. KUMAR [1], N.E. LEEDS [1], G.N. FULLER [1], P. VAN TASSEL [1], M.H. MAOR [1], R.E. SAWAYA [1], V.A. LEVIN [1]
[1]  University of Texas M.D. Anderson CancerCenter Houston, United States.

Purpose. To describe both the commonand less frequently encountered magnetic resonance (MR) imagingfeatures of radiation therapy- and chemotherapy-induced brain injury,with particular emphasis on radiation necrosis.

Materials and methods. A cohort of 148 patients underwentsurgical resection of malignant brain (glial) tumors and were subsequentlyentered into a research protocol that consisted of accelerated radiationtherapy with carboplatin followed by chemotherapy with procarbazine,lomustine, and vincristine. Patients typically underwent sequentialMR imaging at 6-8 week intervals during the 1 st yearand at 3-6 month intervals during subsequent years. In all patients,histopathologic confirmation of lesion composition was performedby neuropathologists.

Results. The patients exhibited different types of MRimaging-detected abnormalities of the brain: pure radiation necrosisin 20 patients, a mixture of predominantly radiation necrosis withlimited recurrent and/or residual tumor (less than 20% ofresected tissue) in 16 patients, radiation necrosis of the cranialnerves and/or their pathways in two patients, radiation-inducedenhancement of the white matter in 52 patients, and radiation-inducedenhancement of the cortex in nine patients. The common and uncommonfeatures of radiation necrosis included radiation necrosis simulatinga recurrent glioma at the site of the surgical cavity in 15 cases, distantto the site of the primary tumor on the ipsilateral side simulating multifocalglioma in 18 cases, or on the contralateral side simulating multicentricglioma in 8 cases, and multiple radiation-induced necrotic massessimulating multiple metastases in 1 case.

Conclusion. The frequent diagnostic dilemma of recurrentneoplasm versus radiation necrosis is addressed in this study througha description of the varying spatial and temporal patterns of radiationnecrosis at MR imaging.

© 2002 Elsevier Masson SAS. Tous droits réservés.
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