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MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay

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Abstract

Radiation to the brain and adjuvant chemotherapy may produce late delayed changes from several months to years after treatment of intracranial malignancies with a reported prevalence of 5–24%. The pattern of treatment-related injury may vary from diffuse periventricular white matter lesions to focal or multifocal lesions. Differentiation of treatment-related injury from tumor progression/recurrence may be difficult with conventional MR imaging (MRI). With both disease processes, the characteristic but nonspecific imaging features are vasogenic edema, contrast enhancement, and mass effect. This pictorial essay presents MRI spectra of late therapy-induced injuries in the brain with a particular emphasis on radiation necrosis, the most common and severe form. Novel MRI techniques, such as diffusion-weighted imaging (DWI), proton MR spectroscopy (MRS), and perfusion MRI, improve the possibilities of better characterization of treatment-related changes. Advanced MRI techniques allow for the assessment of metabolism and physiology and may increase specificity for therapy-induced changes.

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Acknowledgment

Supported by Slovak Scientific Grant Agency VEGA (No. 1/3430/06)

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Authors and Affiliations

  1. Department of Radiology, Derer’s University Hospital, Bratislava, Slovakia

    Ľ. Pružincová, M. Srbecký & V. Belan

  2. Department of Neurosurgery, Comenius University, Bratislava, Slovakia

    J. Šteňo & M. Novotný

  3. Department of Neurology, Comenius University, Bratislava, Slovakia

    P. Kalina

  4. Cytopathos, Centre of Pathology, Derer’s University Hospital, Bratislava, Slovakia

    B. Rychlý

  5. Department of Radiation Oncology, St. Elisabeth Canc. Inst., Bratislava, Slovakia

    E. Bolješíková & M. Chorváth

  6. Department of Nuclear Medicine, Comenius University, Bratislava, Slovakia

    V. Pročka & I. Makaiová

  7. Limbova 5, 83305, Bratislava, Slovakia

    Ľ. Pružincová

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  1. Ľ. Pružincová
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Correspondence to Ľ. Pružincová.

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Pružincová, Ľ., Šteňo, J., Srbecký, M. et al. MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay. Eur Radiol 19, 2716–2727 (2009). https://doi.org/10.1007/s00330-009-1449-8

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  • DOI: https://doi.org/10.1007/s00330-009-1449-8

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