The Role of Susceptibility Weighted Imaging to Evaluate the Radiation Injury of Primary and Metastatic Brain Tumors

Year 2017, Volume: 6 Issue: 1, 14 - 19, 01.01.2017

Hediye Pınar Günbey

https://doi.org/10.5505/abantmedj.2017.17037

Abstract

INTRODUCTION: Radiation injury is frequently seen in patients which have been resected from high-grade brain gliomas, medulloblastomas and metastatic lesions and given radiotherapy RT . Susceptibility-weighted imaging SWI is a MRI technique for detecting small vessels and the residue of blood in microhaemorrhages that can not be displayed with conventional MRI. The aim of this study is to investigate the ability of SWI to detect bleeding sites in patients who received RT due to primer and metastatic brain tumors. METHODS: 13 women mean age 37 ± 19.3 , 10 males mean age 37.3 ± 21 a total of 23 patients who have been irradiated with the pathological diagnosis of primary and metastatic brain tumors were included in the study. Supra and infratentorial SWI lesions were counted and compared with conventional MRI. Localizations were classified as cerebellar, brainstem, basal ganglia and cortical-subcortical, periventricular and deep white matter WM . Lesion counts and the largest lesion diameter were compared with the period after RT.RESULTS: Cerebellar lesions were seen in only 4 patients with medulloblastoma. The cortical-subcortical WM was the most common localization. SWI lesions have been detected most in ependymoma and least in metastases. The largest diameter of the lesions showed a linear relationship with time after RT. The SWI lesion number, operated tumor type, time after RT were not correlated with age and gender p

Keywords

Radiation Injury, Radiotherapy, MRI, Susceptibility

Primer ve Metastatik Beyin Tümörlerinde Radyasyon Hasarını Değerlendirmede Duyarlılık Ağırlıklı Görüntülemenin Rolü

Abstract

GİRİŞ ve AMAÇ: Radyasyon hasarı, rezeke olmuş ve radyoterapi RT verilmiş yüksek dereceli beyin gliomları, medulloblastomlar ve metastatik lezyonları olan olgularda sık görülmektedir. Duyarlılık ağırlıklı görüntüleme DAG , konvansiyonel MR’da görüntülenemeyen küçük damarları ve mikrohemorajiler içindeki rezidü kanı saptamaya yarayan MRG tekniğidir. Bu çalışmanın amacı primer ve metastatik beyin tümörleri nedeniyle RT almış hastalarda DAG ‘nin kanama alanlarını saptama yeteneğini araştırmaktır.YÖNTEM ve GEREÇLER: Primer ve metastatik beyin tümörleri patolojik tanısıyla RT almış ve DAG yapılmış olan 13 kadın ort.yaş 37 ± 19.3 , 10 erkek ort.yaş 37.3 ± 21 toplam 23 hasta çalışmaya dahil edildi. Supra ve infratentoriyel DAG lezyonu sayıldı ve konvansiyonel MR’ları ile karşılaştırıldı. Lokalizasyonlarına göre lezyonlar serebellar, beyin sapı, bazal ganglionlar, kortikal-subkortikal, periventriküler ve derin beyaz cevher BC lezyonları olarak tanımlandı. Lezyon sayıları ve en büyük lezyon çapları, RT sonrası geçen süre ile karşılaştırıldı.BULGULAR: Serebellar lezyonlar sadece dört medulloblastom olgusunda görüldü. Lokalizasyonlarına göre en çok lezyon görülen lokalizasyon kortikal-subkortikal BC idi. DAG lezyonu en fazla epandimom, en az metastaz olgularında saptandı. En büyük lezyon çapları RT sonrası geçen süre ile lineere yakın ilişki gösterdi. DAG’de saptanan lezyon sayıları opere tümör tipi, RT sonrası geçen süre, yaş ve cinsiyet ile korele değildi p>0.005 . En büyük lezyon çapı RT sonrası geçen süre ve tümör tipi ile anlamlı korelasyon göstermedi p>0.005 .TARTIŞMA ve SONUÇ: DAG, primer ve metastatik beyin tümörleri için RT sonrası radyasyon hasarı olan bölgelerdeki mikrokanamaları değerlendirmek ve takip etmek için yararlı bir MRG yöntemidir.

Keywords

Radyasyon Hasarı, Radyoterapi, MRG

References

• Kortmann RD, Kühl J, Timmermann B, Mittler U, Urban C, Budach V, Richter E, Willich N, Flentje M, Berthold F, Slavc I, Wolff J, Meisner C, Wiestler O, Sörensen N, Warmuth-Metz, Bamberg M. Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT ’91. Int J Radiat Oncol Biol Phys 2000;46(2):269– 279.
• Sheline GE, Wara WM, Smith V. Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 1980;6:1215–1228.
• Gaensler EH, Dillon WP, Edwards MS, Larson DA, Rosenau W, Wilson CB. Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging. Radiology 1994;93:629–636.
• Vázquez E, Delgado I, Sánchez-Montañez A, Barber I, Sánchez-Toledo J, Enríquez G. Side effects of oncologic therapies in the pediatric central nervous system: update on 2011;31(4):1123–1139 findings. Radiographics
• Mori N, Miki Y, Kikuta K, Fushimi Y, Okada T, Urayama S, Sawamoto N, Fukuyama H, Hashimoto N, Togashi K. Microbleeds in moyamoya disease: susceptibility- weighted imaging versus T2_-weighted imaging at 3 Tesla. Invest Radiol 2008;43:574–579
• Rauscher A, Sedlacik J, Deistung A, Mentzel H-J, Reichenbach JR. Susceptibility weighted imaging: data acquisition, applications. Z Med Phys 2006;16(4):240–250 and clinical
• Sehgal V, Delproposto Z, Haddar D, Haacke EM, Sloan AE, Zamorano LJ Barger G, Hu J, Xu Y, Prabhakaran PK, Elangovan IR, Neelavalli J, Reichenbach JR. Susceptibility- weighted imaging to visualize blood products and improve tumor contrast in the study of brain masses. J Magn Reson Imaging 2006;24(1):41–51
• Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility weighted imaging: technical aspects and clinical applications, part 2. AJNR Am J Neuroradiol 2009;30(2):232–252
• Bulut HT, Sarıca MA, and Baykan AH. The value of susceptibility weighted magnetic resonance imaging in evaluation of patients with familial cerebral cavernous angioma. Int J Clin Exp Med. 2014;15;7(12):5296-5302
• Haacke EM, Mittal S, Wu Z, Neelavalli J, Cheng Y-CN. Susceptibility-weighted imaging: technical aspects and clinical applications, part 1. AJNR 2009;30(1):19–30
• Valk PE, Dillon WP. Radiation-injury of the brain. Am J Neuroradiol 1991;12(1):45–62
• DeAngelis LM, Delattre JY, Posner JB. Radiation-induced dementia in patients cured of brain metastases. Neurology. 1989; 39(6):789–796.
• Surma-aho O, Niemela M, Vilkki J, Kouri M, Brander A, Salonen O, Paetau A, Kallio M, Pyykkönen J, Jääskeläine L. Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology 2001;56(10):1285– 1290.
• Pruzincova´ L, Steno J, Srbecky´ M, Kalina P, Rychlý B, Bolješíková E, Chorváth M, Novotný M, Pročka V, Makaiová I, Belan V. MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay. Eur Radiol 2009;19:2716–2727
• Chan YL, Leung SF, King AD, Choi PHK, Metreweli C. Late radiation injury to the temporal lobes: morphologic evaluation at MR imaging. Radiology 1999;213:800–807
• Peters S, Pahl R, Claviez A, & Jansen O. Detection of irreversible changes in susceptibility-weighted images after whole-brain irradiation of children. Neuroradiology 2013;55(7), 853-859
• Zeng, QS, Kang XS, Li CF, & Zhou GY. Detection of hemorrhagic hypointense foci in radiation injury region using susceptibility-weighted imaging. Acta Radiologica 2011;52(1), 115-119
• Bian W, Hess CP, Chang SM, Nelson SJ, Lupo JM. Susceptibility-weighted MR imaging of radiation therapy- induced cerebral microbleeds in patients with glioma: a comparison between 3T and 7T. Neuroradiology 2014;56(2), 91-96
• Lupo JM, Chuang CF, Chang SM, Barani IJ, Jimenez B, Hess CP, Nelson SJ. 7-Tesla susceptibility-weighted imaging to assess the effects of radiotherapy on normal-appearing brain in patients with glioma. International Journal of Radiation Oncology* Biology* Physics 2012; 82(3), e493- e500.
• Lew SM, Morgan JN, Psaty E, Lefton DR, Allen JC, Abbott R. Cumulative incidence of radiation-induced cavernomas in long-term survivors of medulloblastoma. J Neurosurg 2006;104(2 Suppl):103–107
• Vinchon M, Leblond P, Caron S, Delestret I, Baroncini M, Coche B. Radiation-induced tumors in children irradiated for brain tumor: a longitudinal study. Childs Nerv Syst 2011;27(3):445–453
• Poussaint TY, Siffert J, Barnes PD, Pomeroy SL, Goumnerova LC, Anthony DC, Sallan SE, Tarbell NJ. Hemorrhagic vasculopathy after treatment of central nervous system neoplasia in childhood: diagnosis and follow-up. AJNR 1995;16(4):693–699
• Lee AW, Ng SH, Ho JH, Tse VK, Poon YF, Tse CC, Au GK, O SK, Lau WH, Foo WW. Clinical diagnosis of late temporal lobe necrosis following radiation therapy for nasopharyngeal carcinoma. Cancer 1988;61:1535–154