Dynamic MRI follow-up of radiation encephalopathy in the temporal lobe following nasopharyngeal carcinoma radiotherapy

Zhou,Xiaofeng; Liao,Xiaofang; Ren,Xiaoqiu; Xiang,Kewei; Hu,Qiongge; Zhang,Minming; He,Huijuan; Shen,Li; Wei,Qichun

doi:10.3892/ol.2017.6199

July-2017 Volume 14 Issue 1

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July-2017 Volume 14 Issue 1

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Article Open Access

Dynamic MRI follow-up of radiation encephalopathy in the temporal lobe following nasopharyngeal carcinoma radiotherapy

Authors:
- Xiaofeng Zhou
- Xiaofang Liao
- Xiaoqiu Ren
- Kewei Xiang
- Qiongge Hu
- Minming Zhang
- Huijuan He
- Li Shen
- Qichun Wei
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Affiliations: Department of Radiation Oncology, The Second Affiliated Hospital, National Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China, Department of Radiation Oncology, Quzhou Central Hospital, Quzhou, Zhejiang 324000, P.R. China, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China

Copyright: © Zhou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 715-724
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Published online on: May 17, 2017

https://doi.org/10.3892/ol.2017.6199
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Abstract

The natural course of radiation encephalopathy following nasopharyngeal carcinoma (NPC) radiotherapy remains poorly understood. The present study aimed to investigate the magnetic resonance imaging (MRI) characteristics and evolution of radiation encephalopathy. A series of 162 follow‑up MRI examinations from 68 NPC patients with radiation encephalopathy in the temporal lobes were analyzed retrospectively. Each component of radiation encephalopathy was defined as follows: i) contrast enhanced lesions were enhanced lesions on contrast enhanced T1‑weighted images (T1WI); ii) white matter lesions were lesions of homogeneous hyperintensity on T2‑weighted images (T2WI) and hypointensity on T1WI; iii) cysts were round or oval well‑defined lesions of hyperintensity on T2WI; iv) hemosiderin deposition were nodular or annular hypointense lesions with lower hypointense than normal white matter on both T1WI and T2WI; v) gray matter lesions were defined as disruption or erosion of hyperintensity in the cortex on T2WI. Contrast enhanced lesions, white matter lesions, gray matter lesions, cysts and hemosiderin deposition were detected in 105 (100.0%), 98 (93.3%), 94 (89.5%), 2 (1.7%) and 2 (1.7%) cases of the 105 initial diagnosed temporal lobe lesions. Contrast enhanced lesions were the most commonly observed, followed by white matter lesions, gray matter lesions, temporal lobe atrophy, cysts and hemosiderin deposition. In addition, 12 new lesions were identified during the follow‑up, 4 of which presented as solid enhanced nodular lesions. Importantly, in 11 of the 117 (9.4%) affected temporal lobes, solid enhanced nodular lesions were observed to be the only initial abnormalities to occur. For those enhanced nodular lesions measuring <0.8 cm, no necrosis could be detected. On the contrary, all the contrast enhanced lesions measuring >2.0 cm exhibited a necrotic core. To the best of our knowledge, the present study revealed for the first time solid enhanced nodular lesions as the earliest MRI abnormalities of radiation encephalopathy following NPC radiotherapy.

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1	Cao SM, Simons MJ and Qian CN: The prevalence and prevention of nasopharyngeal carcinoma in China. Chin J Cancer. 30:114–119. 2011. View Article : Google Scholar : PubMed/NCBI
2	Lee AW, Ng WT, Hung WM, Choi CW, Tung R, Ling YH, Cheng PT, Yau TK, Chang AT, Leung SK, et al: Major late toxicities after conformal radiotherapy for nasopharyngeal carcinoma-patient-and treatment-related risk factors. Int J Radiat Oncol Biol Phys. 73:1121–1128. 2009. View Article : Google Scholar : PubMed/NCBI
3	Jen YM, Shih R, Lin YS, Su WF, Ku CH, Chang CS, Shueng PW, Hwang JM, Liu DW, Chao HL, et al: Parotid gland-sparing 3-dimensional conformal radiotherapy results in less severe dry mouth in nasopharyngeal cancer patients: A dosimetric and clinical comparison with conventional radiotherapy. Radiother Oncol. 75:204–209. 2005. View Article : Google Scholar : PubMed/NCBI
4	Fischer AW and Holfelder H: Lokales amyloid in gehirn. Dtsch Zchir. 227:475–483. 1930. View Article : Google Scholar
5	Zhou GQ, Yu XL, Chen M, Guo R, Lei Y, Sun Y, Mao YP, Liu LZ, Li L, Lin AH and Ma J: Radiation-induced temporal lobe injury for nasopharyngeal carcinoma: A comparison of intensity-modulated radiotherapy and conventional two-dimensional radiotherapy. PLoS One. 8:e674882013. View Article : Google Scholar : PubMed/NCBI
6	Chan YL, Leung SF, King AD, Choi PH and Metreweli C: Late radiation injury to the temporal lobes: Morphorlogic evaluation at MR imaging. Radiology. 213:800–807. 1999. View Article : Google Scholar : PubMed/NCBI
7	Lee AW, Ng SH, Ho JH, Tse VK, Poon YF, Tse CC, Au GK, O SK, Lau WH and Foo WW: Clinical diagnosis of late temporal lobe necrosis following radiation therapy for nasopharyngeal carcinoma. Cancer. 61:1535–1542. 1988. View Article : Google Scholar : PubMed/NCBI
8	Valk PE and Dillon WP: Radiation injury of the brain. AJNR Am J Neuroradiol. 12:45–62. 1991.PubMed/NCBI
9	Husain MM and Garcia JH: Cerebral ‘radiation necrosis’: Vascular and glial features. Acta Neuropathol. 36:381–385. 1976. View Article : Google Scholar : PubMed/NCBI
10	Okeda R and Shibata T: Radiation encephalopathy-an autopsy case and some comments on the pathogenesis of delayed radionecrosis of central nervous system. Acta Pathol Jpn. 23:867–883. 1973.PubMed/NCBI
11	Chan KC, Khong PL, Cheung MM, Wang S, Cai KX and Wu EX: MRI of late microstructural and metabolic alterations in radiation-induced brain injuries. J Magn Reson Imaging. 29:1013–1020. 2009. View Article : Google Scholar : PubMed/NCBI
12	Greene-Schloesser D, Robbins ME, Peiffer AM, Shaw EG, Wheeler KT and Chan MD: Radiation-induced brain injury: A review. Front Oncol. 2:732012. View Article : Google Scholar : PubMed/NCBI
13	Mao YP, Zhou GQ, Liu LZ, Guo R, Sun Y, Li L, Lin AH, Zeng MS, Kang TB, Jia WH, et al: Comparison of radiological and clinical features of temporal lobe necrosis in nasopharyngeal carcinoma patients treated with 2D radiotherapy or intensity-modulated radiotherapy. Br J Cancer. 110:2633–2639. 2014. View Article : Google Scholar : PubMed/NCBI
14	Sun Y, Zhou GQ, Qi ZY, Zhang L, Huang SM, Liu LZ, Li L, Lin AH and Ma J: Radiation-induced temporal lobe injury after intensity modulated radiotherapy in nasopharyngeal carcinoma patients: A dose-volume-outcome analysis. BMC Cancer. 13:3972013. View Article : Google Scholar : PubMed/NCBI
15	Wang YX, King AD, Zhou H, Leung SF, Abrigo J, Chan YL, Hu CW, Yeung DK and Ahuja AT: Evolution of radiation-induced brain injury: MR imaging-based study. Radiology. 254:210–218. 2010. View Article : Google Scholar : PubMed/NCBI
16	Medin PM, Foster RD, van der Kogel AJ, Sayre JW, McBride WH and Solberg TD: Spinal cord tolerance to single-fraction partial-volume irradiation: A swine model. Int J Radiat Oncol Biol Phys. 79:226–232. 2011. View Article : Google Scholar : PubMed/NCBI
17	Medin PM, Foster RD, van der Kogel AJ, Sayre JW, McBride WH and Solberg TD: Spinal cord tolerance to reirradiation with single-fraction radiosurgery: A swine model. Int J Radiat Oncol Biol Phys. 83:1031–1037. 2012. View Article : Google Scholar : PubMed/NCBI
18	Norris AM, Carrington BM and Slevin NJ: Late radiation change in the CNS: MR imaging following gadolinium enhancement. Clin Radiol. 52:356–362. 1997. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Dynamic MRI follow-up of radiation encephalopathy in the temporal lobe following nasopharyngeal carcinoma radiotherapy

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