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Late Radiation Injury to the Temporal Lobes: Morphologic Evaluation at MR Imaging¹

¹ From the Departments of Diagnostic Radiology and Organ Imaging (Y.L.C., A.D.K., C.M.) and Clinical Oncology (S.F.L., P.H.K.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China. Received June 23, 1998; revision requested September 3; revision received March 3, 1999; accepted July 1. Address reprint requests to Y.L.C. (e-mail: yl190chan@cuhk.edu.hk).

PURPOSE: To study the morphologic characteristics of late radiation injury to the temporal lobes of the brain on magnetic resonance (MR) images.

MATERIALS AND METHODS: This was a prospective study involving 34 patients (age range, 37–72 years) with known radiation injury to the temporal lobes from radiation therapy administered 2–10 years previously for nasopharyngeal carcinoma. MR imaging was performed with T2-weighted gradient- and spin-echo, gradient-recalled echo, T1-weighted spin-echo, fluid-attenuated inversion-recovery, and T1-weighted postcontrast spin-echo sequences.

RESULTS: Radiation injury was present in 57 of the 68 temporal lobes. The white matter lesions in radiation-induced injury were predominantly hyperintense on T2-weighted images, but in 37 (65%) of the 57 lobes, foci with heterogeneous signal intensity consistent with necrosis were detected. In the 57 involved lobes, gray matter lesions were detected in 50 (88%); blood-brain barrier disruption based on parenchymal contrast enhancement, in 51 (89%); and hemosiderin deposits, in 30 (53%). There was a significant correlation between white matter necrosis, gray matter lesions, and blood-brain barrier disruption, all of which were located mainly in the inferior temporal lobes that received the highest radiation dose.

CONCLUSION: The lesion components of radiation-induced injury to the temporal lobes at MR imaging were more varied than have been previously described. In addition to the classic white matter lesions, gray matter lesions, blood-brain barrier disruption, and hemosiderin deposition also were frequently seen.

Index terms: Brain, MR, 134.121411, 134.121412, 134.121413, 134.12143 • Brain, necrosis, 10.47, 134.47 • Gadolinium • Magnetic resonance (MR), pulse sequences, 134.121411, 134.121412, 134.121413, 134.12143 • Radiations, injurious effects, complications of therapeutic radiology, 10.47, 134.47

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