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Malignant Gliomas: MR Imaging Spectrum of Radiation Therapy- and Chemotherapy-induced Necrosis of the Brain after Treatment¹

¹ From the Division of Diagnostic Imaging (A.J.K., N.E.L., P.V.T.), and the Departments of Pathology (G.N.F.), Radiation Oncology (M.H.M.), Neurosurgery (R.E.S.), and Neuro-Oncology (V.A.L.), University of Texas M.D. Anderson Cancer Center, Box 57, 1515 Holcombe Blvd, Houston, TX 77030. From the 1995 RSNA scientific assembly. Received October 20, 1999; revision requested November 19; final revision received March 17, 2000; accepted April 24. V.A.L. and G.N.F. supported in part by NIH grant CA 55261. Address correspondence to A.J.K. (e-mail: akumar@mdanderson.org).

PURPOSE: To describe both the common and less frequently encountered magnetic resonance (MR) imaging features of radiation therapy– and chemotherapy-induced brain injury, with particular emphasis on radiation necrosis.

MATERIALS AND METHODS: A cohort of 148 adult patients underwent surgical resection of malignant brain (glial) tumors and were subsequently entered into a research protocol that consisted of accelerated radiation therapy with carboplatin followed by chemotherapy with procarbazine, lomustine, and vincristine. Patients typically underwent sequential MR imaging at 6–8-week intervals during the 1st year and at 3–6-month intervals during subsequent years. In all patients, histopathologic confirmation of lesion composition was performed by board-certified neuropathologists.

RESULTS: The patients exhibited different types of MR imaging–detected abnormalities of the brain: pure radiation necrosis in 20 patients, a mixture of predominantly radiation necrosis with limited recurrent and/or residual tumor (less than 20% of resected tissue) in 16 patients, radiation necrosis of the cranial nerves and/or their pathways in two patients, radiation-induced enhancement of the white matter in 52 patients, and radiation-induced enhancement of the cortex in nine patients.

CONCLUSION: The frequent diagnostic dilemma of recurrent neoplasm versus radiation necrosis is addressed in this study through a description of the varying spatial and temporal patterns of radiation necrosis at MR imaging.

Index terms: Brain, necrosis, 13.47 • Brain neoplasms, 13.363 • Brain neoplasms, MR, 13.121411, 13.121415, 13.12143 • Brain neoplasms, therapeutic radiology • Radiations, injurious effects, complications of therapeutic radiology, 13.47

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