Gadolinium-DTPA Enhancement of Lung Radiation Fibrosis

Wc, Werthmuller; Schiebler, Mark L.; Ra, Whaley; Mauro, Matthew A.; Wh, McCartney

doi:10.1097/00004728-198911000-00002

Cited by 17 publications

(5 citation statements)

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“…Because radiation pneumonitis can have increased FDG uptake that mimics recurrent disease, FDG PET is best performed at least 3 months after completion of radiation therapy. Although CT, MR imaging, and PET often allow differentiation of recurrent tumor from radiation fibrosis, there are instances when definitive diagnosis with invasive procedures such as bronchoscopy, percutaneous needle aspiration biopsy, open lung biopsy, or thoracentesis is required (55)(56)(57)(58)(59) (Fig 15).…”

Section: Differential Diagnosismentioning

confidence: 99%

Effects of Radiation Therapy on the Lung: Radiologic Appearances and Differential Diagnosis

Choi¹,

Munden²,

Erasmus³

et al. 2004

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Radiation-induced lung disease (RILD) due to radiation therapy is common. Radiologic manifestations are usually confined to the lung tissue within the radiation port and are dependent on the interval after completion of treatment. In the acute phase, RILD typically manifests as ground-glass opacity or attenuation or as consolidation; in the late phase, it typically manifests as traction bronchiectasis, volume loss, and scarring. However, the use of oblique beam angles and the development of newer irradiation techniques such as three-dimensional conformal radiation therapy can result in an unusual distribution of these findings. Awareness of the atypical manifestations of RILD can be useful in preventing confusion with infection, recurrent malignancy, lymphangitic carcinomatosis, and radiation-induced tumors. In addition, knowledge of radiologic findings that are outside the expected pattern for RILD can be useful in diagnosis of infection or recurrent malignancy. Such findings include the late appearance or enlargement of a pleural effusion; development of consolidation, a mass, or cavitation; and occlusion of bronchi within an area of radiation-induced fibrosis. A comprehensive understanding of the full spectrum of these manifestations is important to facilitate diagnosis and management in cancer patients treated with radiation therapy.

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Section: Differential Diagnosismentioning

confidence: 99%

Effects of Radiation Therapy on the Lung: Radiologic Appearances and Differential Diagnosis

Choi¹,

Munden²,

Erasmus³

et al. 2004

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285

214

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“…This MRI feature is attributed to edema and may be indicative of chronic vascular injury or ongoing inflammation. In some cases, mature radiation-induced fibrosis may enhance post contrast 8-15 years after therapy [14,20]. Two explanations were offered: either "enhancement by microscopic fibrosis" or "a persistent vasculative leak related to radiotherapy" [14].…”

Section: Discussionmentioning

confidence: 99%

Radiation-Induced Plexopathy and Fibrosis

et al. 2004

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Purpose: To investigate magnetic resonance imaging (MRI) features of radiation-induced plexopathy (RIP) and radiation-induced fibrosis frequently associated with RIP. Patients and Methods: Seven patients with late radiation sequelae in the supraclavicular region were examined with MRI after a median interval of 7 years (range, 5-18 years) following radiotherapy and 4-7 years after the onset of RIP. Four patients had RIP plus severe soft-tissue fibrosis, two RIP without soft-tissue fibrosis (n = 2/6), and one patient fibrosis without RIP. Patients underwent surgery of breast cancer (n = 6) or chest wall relapse (n = 1) and radiotherapy to the supraclavicular fossa with cobalt with an anterior portal in fractions of 1.7-2.6 Gy to 43-51.6 Gy in 3 cm depth. All patients were relapse-free at the time of MRI. Fibrosis and RIP were scored clinically (RTOG classification). Fibrosis of the supraclavicular and/or axillary region was marked in three and mild in two patients. RIP was mild, marked and severe in two patients each. MRI was performed with a 1.5-T unit including coronal STIR, coronal and transversal T2-weighted, transversal T1-weighted and fat-saturated post-contrast (gadolinium-DTPA) spin echo sequences. Results: The brachial plexus appeared normal in all patients, but subtle changes of adjoining tissue (slight, linear signal intensity in T2-weighted images or contrast enhancement surrounding the plexus) were detected in patients with RIP (n = 4/6) and the patient without RIP (n = 1). However, alterations of the soft tissue (marked signal intensity in T2-weighted sequences) correlated well with the clinical degree of fibrosis and were restricted to areas of marked to severe fibrosis (n = 3/3). Conclusion: Reliable MRI signs of RIP could not be identified. The severity of fibrosis closely corresponded to MRI features. The role of MRI in the diagnostic work-up of RIP is, therefore, the exclusion of tumor relapse.Ziel: Die Darstellung der radiogenen Schädigung des Plexus brachialis (RP) und der häufig mit der RP assoziierten Weichteilfibrose mit der Magnetresonanztomographie (MRT) wurde untersucht. Patienten und Methodik: Sieben Patientinnen mit ausgeprägten Strahlenreaktionen in der Supraklavikularregion wurden median 7 Jahre nach Therapie untersucht. Vier Patientinnen hatten eine RP und Fibrose, zwei Patientinnen eine RP ohne Fibrose und eine Patientin eine Fibrose ohne RP. Im Rahmen der Primärtherapie (n = 6) bzw. nach Exzision eines Brustwandrezidivs (n = 1) wurde die Supraklavikularregion mit 60 Co in Einzeldosen von 1,7-2,6 Gy bis zu einer Gesamtdosis von 43-51,6 Gy in 3 cm Tiefe bestrahlt. Die Patientinnen waren seit mindestens 4 Jahren rezidivfrei. Fibrose und RP wurden klinisch nach RTOG klassifiziert. Die MRT-Untersuchung wurde an einem 1,5-T-Gerät mit koronaren und transversalen T2-gewichteten Sequenzen, koronaren STIR, transversalen T1-gewichteten Sequenzen und fettgesättigten Spinechosequenzen nach Kontrastmittelgabe (Gadolinium-DTPA) durchgeführt. Ergebnisse: Der Plexus brachialis selbst stellte sich ...

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“…Unfortunately, the consolidation of radiation pneumonitis and the fibrosis and contraction of the radiation-induced solid consolidation may confound the evaluation of posttreatment changes (2). It had been hoped that magnetic resonance (MR) imaging would facilitate the differentiation of recurrent tumor from radiation fibrosis, but MR imaging has not proved to be as helpful as had been hoped (3)(4)(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%