Malignant Gliomas: MR Imaging Spectrum of Radiation Therapy- And Chemotherapy-Induced Necrosis of the Brain After Treatment

Radiology. 2000 Nov;217(2):377-84. doi: 10.1148/radiology.217.2.r00nv36377.

Abstract

Purpose: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Agents / adverse effects*
  • Brain / drug effects
  • Brain / pathology*
  • Brain / radiation effects
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / therapy*
  • Diagnosis, Differential
  • Female
  • Glioma / diagnosis
  • Glioma / therapy*
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Necrosis
  • Neoplasm Recurrence, Local
  • Radiation Injuries / diagnosis*

Substances

  • Antineoplastic Agents