MRI of radiation injury to the brain

Curnes, John T.; Laster, Dan W; Ball, M. R.; Moody, Dixon M.; Witcofski, Richard L.

doi:10.2214/ajr.147.1.119

Cited by 68 publications

(28 citation statements)

References 6 publications

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“…In the 19 patients examined no abnormality was detected. Indeed, Tl values lay towards the lower end of the quoted normal range of 265-292 ms (Kean & Smith, 1986), with no suggestion of the non-specific prolongation observed by others (Curnes et al, 1986).…”

Section: Discussionmentioning

confidence: 92%

“…Only one study to date has demonstrated a correlation between CT scan abnormalities and impaired psychometry (Brouwers et al, 1985); the present study did not show any relationship, possibly as the changes in both parameters were small. MRI was included as it is more sensitive than CT in detecting white matter disease (Curnes et al, 1986). In the 19 patients examined no abnormality was detected.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Minimal neuropsychological sequelae following prophylactic treatment of the central nervous system in adult leukaemia and lymphoma

Tucker

Prior²,

Green³

et al. 1989

Br J Cancer

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Summary The potential long-term toxicity of central nervous system prophylaxis (CNS-P) in adult acute lymphoblastic leukaemia (ALL, n = 17) and non-Hodgkin's lymphoma (NHL, n = 7) was investigated in a multidisciplinary study. At least 4 years had elapsed from CNS-P (mean 11.5 years) for all patients. Neurological history and physical examination were unremarkable; minor signs were commoner in older patients (P< 0.02). Psychometry yielded normal results, but individual verbal IQ generally exceeded performance IQ, with a trend to more marked differences in younger adults (P = 0.06). EEG was scored and differed significantly from that of controls, with a tendency to more marked (but still minor) abnormalities in younger patients (P = 0.06). Brainstem auditory evoked potentials demonstrated significant but generally minor abnormality in 24% of patients. CT brain scan revealed widening of cerebral hemisphere sulci to >3 mm in 38% of patients; cerebral atrophy was commoner in the older group (P< 0.02) and those with neurological signs (P<0.02). MRI brain scans were normal in all patients tested. Thus, following standard CNS-P for ALL at this hospital, there is a 5% primary CNS relapse rate, and only minimal, mainly subclinical, long-term neuropsychological toxicity.An important aspect of the 'total therapy' concept for treatment of childhood acute lymphoblastic leukaemia (ALL) is the specific prophylactic treatment of the central nervous system (CNS-P) (Aur et al., 1971; Report to the Medical Research Council, 1973). The combination of external cranial irradiation to 24 Gy with five doses of intrathecal methotrexate has reduced the primary CNS relapse rate from about 75% to 10% or less. In the late 1970s reports emerged indicating that long-term survivors of childhood ALL appeared to have subnormal IQ, typically presenting with learning difficulties (Meadows et al., 1981; Eiser et al., 1978;Moss et al., 1981;Carli et al., 1985). It is now apparent that long-term CNS problems may range in severity from minor intellectual dysfunction to severe neuropsychological damage, seizures and dementia (Bleyer, 1981).As ALL is less common in adults than in children, the former have received less attention regarding the potential neurotoxicity of CNS-P. Intensive therapy of adult ALL may now yield survival figures approaching those for children (Linker et al., 1987;Omura et al., 1980). It is therefore increasingly important to look for possible long-term adverse effects of therapy. To our knowledge there are no published data addressing this issue. The results of a multidisciplinary investigation of adults with ALL and NHL who received standard CNS-P are presented. Materials and methods PatientsAcute tymphoblastic leukaemia Between 1972 and 1982, 112 consecutive, previously (Lister et al., 1978). In 1986, 12 patients were alive; seven were available for study. Two patients were lost to follow-up, one patient refused to be studied, and two patients were excluded due to a past history of encephalitis and meningitis respectively...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Minimal neuropsychological sequelae following prophylactic treatment of the central nervous system in adult leukaemia and lymphoma

Tucker

Prior²,

Green³

et al. 1989

Br J Cancer

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“…19) Whole brain radiation (WBR) is recommended for patients with high-grade malignant gliomas or central nervous system (CNS) lymphomas, and for those undergoing craniospinal irradiation for medulloblastoma or CNS prophylaxis for leukemia. 10,19,28,32) However, cognitive impairment or mental retardation in children 5,6,28) and psychomotor disturbance or severe dementia in the elderly 3,10,16,20) are frequently reported. Such adverse reactions to WBR have been attributed to radiation encephalopathy 1,8) or (delayed) radiation necrosis.…”

Section: Introductionmentioning

confidence: 99%

“…Such adverse reactions to WBR have been attributed to radiation encephalopathy 1,8) or (delayed) radiation necrosis. 22,36,37) Computed tomography and magnetic resonance (MR) imaging studies of the head in the patients have shown evidence of progressive brain atrophy 1,5,[36][37][38] or global damage of the cerebral white matter. 1,8) Autopsy of the brain has demonstrated myelin damage.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Dysfunction and Histological Findings in Adult Rats One Year After Whole Brain Irradiation.

Akiyama

Tanaka

Sato

et al. 2001

Neurol. Med. Chir.(Tokyo)

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Cognitive dysfunction and histological changes in the brain were investigated following irradiation in 20 Fischer 344 rats aged 6 months treated with whole brain irradiation (WBR) (25 Gy/single dose), and compared with the same number of sham-irradiated rats as controls. Performance of the Morris water maze task and the passive avoidance task were examined one year after WBR. Finally, histological and immunohistochemical examinations using antibodies to myelin basic protein (MBP), glial fibrillary acidic protein (GFAP), and neurofilament (NF) were performed of the rat brains. The irradiated rats continued to gain weight 7 months after WBR whereas the control rats stopped gaining weight. Cognitive functions in both the water maze task and the passive avoidance task were lower in the irradiated rats than in the control rats. Brain damage consisting of demyelination only or with necrosis was found mainly in the body of the corpus callosum and the parietal white matter near the corpus callosum in the irradiated rats. Immunohistochemical examination of the brains without necrosis found MBP-positive fibers were markedly decreased in the affected areas by irradiation; NF-positive fibers were moderately decreased and irregularly dispersed in various shapes in the affected areas; and GFAP-positive fibers were increased, with gliosis in those areas. These findings are similar to those in clinically accelerated brain aging in conditions such as Alzheimer's disease, Binswanger's disease, and multiple sclerosis.

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“…However, early diagnosis of radiation-induced damage, followed by steroid treatment sometimes im proves outcome. Both computed tomography (CT) or magnetic resonance (MR) imaging may be nonspecific in the diagnosis of brain injury induced by radiation [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Demonstration of Cerebral Radiation Injury with Metabolic Positron Emission Tomography Images

et al. 1991

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A 2-year-old girl with medulloblastoma who had postoperative radiotherapy and intrathecal administration of methotrexate is reported. Five months after radiation and chemotherapy, she developed involuntary movement. Positron emission tomography (PET) demonstrated that the metabolic rate of glucose was depressed markedly in the temporal and occipital lobes, indicative of metabolic depression induced by radiation. Prompt initiation of steroid therapy ameliorated the patient’s neurological symptoms. Follow-up PET revealed an increase in ¹⁸F-fluorodeoxyglucose uptake in the entire brain, including temporal and occipital lesions. No areas with high accumulation of (¹¹C-methyl)-L-methionine were detectable. We concluded that PET may be useful in establishing an early diagnosis of radiation injury of the brain and in monitoring metabolic changes following radiation in brain tumor patients.

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MRI of radiation injury to the brain

Cited by 68 publications

References 6 publications

Minimal neuropsychological sequelae following prophylactic treatment of the central nervous system in adult leukaemia and lymphoma

Minimal neuropsychological sequelae following prophylactic treatment of the central nervous system in adult leukaemia and lymphoma

Cognitive Dysfunction and Histological Findings in Adult Rats One Year After Whole Brain Irradiation.

Demonstration of Cerebral Radiation Injury with Metabolic Positron Emission Tomography Images

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