Imaging spectrum of immunomodulating, chemotherapeutic and radiation therapy-related intracranial effects

Br J Radiol. 2018 Feb;91(1082):20170553. doi: 10.1259/bjr.20170553. Epub 2017 Nov 3.


Objective: A wide range of treatment-related side effects result in specific neurologic symptoms and signs and neuroimaging features. Even to the most seasoned neuroradiologist, elucidating therapy-related side effects from other common mimics can be challenging. We provide a pictorial survey of some common and uncommon medication-induced and therapy-related neuroimaging manifestations, discuss pathophysiology and common pitfalls in imaging and diagnosis.

Methods: A case-based review is utilized to depict scenarios on a routine basis in a general radiology or neuroradiology practice such as medication-induced posterior reversible encephalopathy syndrome to the more challenging cases of pseudoprogression and pseudoregression in temozolmide and bevacizumab therapy in gliobastoma treatment protocols.

Conclusion: Knowledge of the treatment-induced imaging abnormalities is essential in the accurate interpretation and diagnosis from the most routine to most challenging of clinical situations. We provide a pictorial review for the radiologist to employ in order to be an invaluable provider to our clinical colleagues and patients.

Publication types

  • Review

MeSH terms

  • Autoimmune Hypophysitis / diagnostic imaging*
  • Autoimmune Hypophysitis / etiology
  • Brain / diagnostic imaging*
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / pathology
  • Demyelinating Diseases / diagnostic imaging*
  • Demyelinating Diseases / etiology
  • Diagnostic Imaging / methods
  • Disease Progression
  • Drug-Related Side Effects and Adverse Reactions*
  • Glioblastoma / diagnostic imaging
  • Glioblastoma / pathology
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / diagnostic imaging*
  • Immune Reconstitution Inflammatory Syndrome / etiology
  • Multiple Sclerosis / drug therapy
  • Posterior Leukoencephalopathy Syndrome / diagnostic imaging*
  • Posterior Leukoencephalopathy Syndrome / etiology
  • Radiotherapy / adverse effects