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. 2013 Feb;34(2):446-50.
doi: 10.3174/ajnr.A3219. Epub 2012 Jul 19.

Imaging Changes in Very Young Children With Brain Tumors Treated With Proton Therapy and Chemotherapy

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Free PMC article

Imaging Changes in Very Young Children With Brain Tumors Treated With Proton Therapy and Chemotherapy

N D Sabin et al. AJNR Am J Neuroradiol. .
Free PMC article

Abstract

PT promises to reduce side effects in children with brain tumors by sparing normal tissue compared with 3D conformal or intensity-modulated radiation therapy. Information is lacking about the combined effects of PT and chemotherapy in young children. We describe imaging changes in 8 very young children with localized brain tumors who received PT after chemotherapy. Mostly transient signal abnormalities and enhancement in brain parenchyma were observed by serial MR imaging, which were consistent with radiation-induced effects on normal-appearing tissue. Correlation with PT planning data revealed that the areas of imaging abnormality were located within or adjacent to the volume that received the highest radiation dose. Radiologists should be aware of these findings in children who receive PT after chemotherapy. In this report, we describe the time course of these PT-related imaging findings and correlate them with treatment and clinical outcomes.

Figures

Figure 1
Figure 1
Axial T2-weighted (left) and axial post-gadolinium T1-weighted (right) images through the posterior fossa of patient 2, acquired 3.6 months after completion of PT, reveal prominent T2 prolongation and heterogeneous enhancement within the pons. This portion of the pons was in the high dose volume of irradiation.
Figure 2
Figure 2
Axial FLAIR (a) and post-gadolinium coronal T1-weighted (b) images for patient 6, obtained 4.2 months after completion of PT, demonstrate patchy hyperintensity (FLAIR) and focal irregular enhancement (arrows in b) within the pons. Diffusion-weighted (c) and apparent diffusion coefficient map (d) images reveal small areas of restricted diffusion in the areas of abnormal signal and enhancement. This portion of the pons was in the high dose volume of irradiation. The abnormalities improved on an MRI study obtained 1.5 months later and were no longer visible 4 months after they first appeared (e and f).
Figure 3
Figure 3
Axial T2 (left) and axial post-gadolinium T1-weighted (right) images through the level of the thalami for patient 4 demonstrate enlargement of the right thalamus with hyperintensity on the T2-weighted image without enhancement (arrows).
Figure 4
Figure 4
Reformatted axial post-gadolinium T1-weighted magnetization-prepared rapid gradient echo image through the posterior fossa of patient 8, co-registered to the proton therapy treatment plan, demonstrates two areas of enhancement within the pons (outlined in yellow) located within the high-dose volume of irradiation (orange color wash).

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