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AJNR - American Journal of Neuroradiology

Published ahead of print on January 17, 2008
doi: 10.3174/ajnr.A0886

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Benign Ulceration as a Manifestation of Soft Tissue Radiation Necrosis: Imaging Findings

J.M. Debnam^a, A.S. Garden^b and L.E. Ginsberg^a

^a Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Tex
^b Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Tex

View larger version (82K): [in this window] [in a new window]   Fig 1. Patient 3, a 46-year-old man status post 7 months of radiation therapy (72 Gy) for treatment of a squamous cell carcinoma of the left oropharynx, with a nonenhancing ulceration with negative biopsy results (category 1) in the left oropharynx (arrows). This patient has been followed for 11.5 months since initial diagnosis without evidence of tumor recurrence.

View larger version (53K): [in this window] [in a new window]   Fig 2. Patient 5, a 59-year-old woman status post 3.5 months of radiation therapy (60 Gy) for treatment of squamous cell carcinoma of the oral tongue, with a nonenhancing ulceration with negative biopsy results (category 1). This patient has been followed for 16 months since initial diagnosis without evidence of tumor recurrence. A, Contrast-enhanced CT with ulceration in the right lateral part of the oral tongue (arrows). B, PET/CT with 18F-FDG activity (SUV, 12 mg/mL) along the posterior border (arrows) on the ulceration, suspicious for a recurrent tumor.

View larger version (94K): [in this window] [in a new window]   Fig 3. Patient 11, a 75-year-old woman status post 5 months of radiation therapy (70 Gy) for treatment of squamous cell carcinoma of the left oropharyngeal wall, with a nonenhancing ulceration of the left oropharynx (arrow) in which a biopsy was not performed (category 2). This patient has been followed for 30 months since initial diagnosis without evidence of tumor recurrence.

View larger version (52K): [in this window] [in a new window]   Fig 4. Patient 13, a 46-year-old man status post 7 months of radiation therapy (70 Gy) for treatment of a squamous cell carcinoma of the left oropharynx and hypopharynx, with an enhancing ulceration with positive biopsy results (category 3) of the left pyriform sinus. A, Contrast-enhanced CT with an enhancing ulceration of the pyriform sinus (arrows). B, PET/CT with 18F-FDG activity (SUV, 4.6 mg/mL) along the posterior border of the ulceration (arrow).

View larger version (71K): [in this window] [in a new window]   Fig 5. Patient 18, a 70-year-old men status post 61 months of radiation therapy for treatment of a squamous cell carcinoma of the larynx, followed by total laryngectomy with an enhancing ulceration with negative biopsy results (category 4) of the base of the tongue. There is adjacent peripheral and nodular enhancement (arrows). This patient has been followed for 19.5 months since initial diagnosis without evidence of tumor recurrence.

View larger version (87K): [in this window] [in a new window]   Fig 6. Patient 19, a 64-year-old man status post 5 months of radiation therapy (70 Gy) for treatment of a squamous cell carcinoma of the left tonsil, with an enhancing ulceration in the left oropharyngeal wall (arrows) in which biopsy was not performed (category 5). This patient has been followed for 20 months since initial diagnosis without evidence or tumor recurrence.