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Susceptibility-weighted imaging in stroke-like migraine attacks after radiation therapy syndrome

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Introduction

Stroke-like migraine attacks after radiation therapy (SMART) syndrome has a characteristic clinical presentation and postcontrast T1WI MRI appearance. Susceptibility-weighted imaging (SWI) may help distinguish SMART from other disorders that may have a similar postcontrast MRI appearance.

Methods

The MRI examinations of four patients with SMART syndrome are described herein, each of which included SWI, FLAIR, DWI, and postcontrast T1WI on the presenting and follow-up MRI examinations.

Results

In each, the initial SWI MRI demonstrated numerous susceptibility hypointensities <5 mm in size throughout the cerebrum, particularly within the periventricular white matter (PVWM), presumably related to radiation-induced cavernous hemangiomas (RICHs). By follow-up MRI, each postcontrast examination had demonstrated resolution of the gyriform enhancement on T1WI, without susceptibility hypointensities on SWI within those previously enhancing regions.

Conclusion

These preliminary findings suggest that SWI may help identify SMART syndrome or at least help discriminate it from other disorders, by the findings of numerous susceptibility hypointensities on SWI likely representing RICHs, gyriform enhancement on T1WI, and postsurgical findings or appropriate clinical history.

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Abbreviations

PVWM:

Periventricular white matter

RICH:

Radiation-induced cavernous hemangiomas

SMART:

Stroke-like migraine attacks after radiation therapy

SWI:

Susceptibility-weighted imaging

T1WI:

T1-weighted imaging

T2*WI:

T2*-weighted (gradient echo) imaging

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the Institutional Internal Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, University Of Minnesota, 420 Delaware St. SE, B-226 Mayo Memorial Building, Minneapolis, MN, 55455, USA

    Sara Khanipour Roshan, Michael B. Salmela & Alexander M. McKinney

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  1. Sara Khanipour Roshan
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  2. Michael B. Salmela
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  3. Alexander M. McKinney
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Correspondence to Sara Khanipour Roshan.

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Khanipour Roshan, S., Salmela, M.B. & McKinney, A.M. Susceptibility-weighted imaging in stroke-like migraine attacks after radiation therapy syndrome. Neuroradiology 57, 1103–1109 (2015). https://doi.org/10.1007/s00234-015-1567-8

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  • DOI: https://doi.org/10.1007/s00234-015-1567-8

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