Susceptibility-weighted magnetic resonance imaging of cerebrovascular sequelae after radiotherapy for pediatric brain tumors

Neu, Marie A.; Tanyildizi, Yasemin; Wingerter, Arthur; Henninger, Nicole; Malki, Khalifa El; Alt, Francesca; Doerr, Barbara; Schmidberger, Heinz; Stockinger, Marcus; Wagner, Wolfgang; Keweloh, Stefanie; Brockmann, Marc A.; Russo, Alexandra; Faber, Joerg

doi:10.1016/j.radonc.2018.03.010

Cited by 25 publications

(17 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior investigations included 1.5 T MRI and T2* GRE sequences and as such had lower sensitivity for smaller microbleeds 13 . Similar to our study, Neu et al, using SWI on a 3 T MRI platform, found that 36 of 40 (90%) of brain tumor survivors treated with cranial radiation had microbleeds at a mean of 13.5 years after diagnosis 14 and the total number of microbleeds correlated with greater whole brain radiation dose and time since diagnosis. A recent study of 113 adult brain tumor patients treated with cranial radiation who received serial SWI's at 7 T were found to have an 18% increase in volume and 11% increase in number of microbleeds per year 15 .…”

Section: Discussionsupporting

confidence: 90%

Cerebral microbleeds in adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiation

Phillips¹,

Hillenbrand²,

Mitrea³

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Cranial radiation therapy is associated with white matter-specific brain injury, cortical volume loss, mineralization, microangiopathy and neurocognitive impairment in survivors of childhood acute lymphoblastic leukemia. In this retrospective cross-sectional analysis, neurocognitive testing and 3 T brain MRI's were obtained in 101 survivors treated with cranial radiation. Small focal intracerebral hemorrhages only visible on exquisitely sensitive MRI sequences were identified and localized using susceptibility weighted imaging. Modified Poisson regression was used to assess the effect of cranial radiation on cumulative number and location of microbleeds in each brain region, and multiple linear regression was used to evaluate microbleeds on neurocognitive outcomes, adjusting for age at diagnosis and sex. At least one microbleed was present in 85% of survivors, occurring more frequently in frontal lobes. Radiation dose of 24 Gy conveyed a 5-fold greater risk (95% CI 2.57-10.32) of having multiple microbleeds compared to a dose of 18 Gy. No significant difference was found in neurocognitive scores with either the absence or presence of microbleeds or their location. Greater prevalence of microbleeds in our study compared to prior reports is likely related to longer time since treatment, better sensitivity of SWI for detection of microbleeds and the use of a 3 T MRI platform.The aims of the current study were to evaluate survivors of childhood ALL during adulthood using 3 T MRI and a well-established high quality microbleed sensitive sequence to examine if relatively low doses of cranial radiation were associated with the development of microbleeds, and to investigate if the presence, frequency and/or location of microbleeds was associated with neurocognitive impairment. Scientific RepoRtS |(2020) 10:692 | https://doi.

show abstract

Section: Discussionsupporting

confidence: 90%

Cerebral microbleeds in adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiation

Phillips¹,

Hillenbrand²,

Mitrea³

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Radiotherapy is essential for the treatment of many CBTs, but it causes significant damage to the brain vasculature and can cause early CVD. 1–7 , 13 , 17–19 , 21 , 30–32 In this study, most of the long-term CBT survivors who received radiotherapy developed CVD, and the cumulative prevalence of CVD at 20 years of follow-up (52%) was alarmingly high. The rates of ischemic infarct, microbleeds, and lacunar infarct were similar to or higher than those in the general population age 70 years or older, which suggests accelerated aging of the cerebral vasculature.…”

Section: Discussionmentioning

confidence: 63%

“…Knowledge about CVD in survivors of CBTs treated with radiotherapy is based on reports of cavernomas, microbleeds, and large-vessel vasculopathy visualized using magnetic resonance imaging (MRI). 6 , 13 , 17–19 Compared with healthy populations, survivors of CBTs treated with radiotherapy have up to a 100-fold increased risk of stroke. 2–4 , 7 However, to date, knowledge about increased stroke risk has been derived from registr y data or self-reports.…”

mentioning

confidence: 99%

“… 1 , 20–22 The imaging findings described in CBT survivors that are related to small-vessel disease include microbleeds, cavernomas, and lacunar infarcts. 5 , 6 , 13 , 17 , 22 White matter lesions (WMLs) are classified as a small-vessel disease in the general population, but in CBT survivors, the etiology is multifactorial. 22 , 23 Large-vessel disease includes ischemic infarcts, large-vessel vasculopathy, and transient ischemic attacks (TIAs).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Radiation-induced accelerated aging of the brain vasculature in young adult survivors of childhood brain tumors

Remes

Suo‐Palosaari

Koskenkorva

et al. 2020

Neuro-Oncology Practice

View full text Add to dashboard Cite

Abstract Background Cranial radiotherapy may damage the cerebral vasculature. The aim of this study was to understand the prevalence and risk factors of cerebrovascular disease (CVD) and white matter hyperintensities (WMHs) in childhood brain tumors (CBT) survivors treated with radiotherapy. Methods Seventy CBT survivors who received radiotherapy were enrolled in a cross-sectional study at a median 20 years after radiotherapy cessation. The prevalence of and risk factors for CVD were investigated using MRI, MRA, and laboratory testing. Tumors, their treatment, and stroke-related data were retrieved from patients’ files. Results Forty-four individuals (63%) had CVD at a median age of 27 years (range, 16-43 years). The prevalence rates at 20 years for CVD, small-vessel disease, and large-vessel disease were 52%, 38%, and 16%, respectively. Ischemic infarcts were diagnosed in 6 survivors, and cerebral hemorrhage in 2. Lacunar infarcts were present in 7, periventricular or deep WMHs in 34 (49%), and mineralizing microangiopathy in 21 (30%) survivors. Multiple pathologies were detected in 44% of the participants, and most lesions were located in a high-dose radiation area. Higher blood pressure was associated with CVD and a presence of WMHs. Higher cholesterol levels increased the risk of ischemic infarcts and WMHs, and lower levels of high-density lipoprotein and higher waist circumference increased the risk of lacunar infarcts. Conclusions Treating CBTs with radiotherapy increases the risk of early CVD and WMHs in young adult survivors. These results suggest an urgent need for investigating CVD prevention in CBT patients.

show abstract

“…Radiotherapy-induced CMBs are common [7,41,[50][51][52], but the prevalence depends on many factors including age of the study population, radiation doses and fields, types of MRI sequences and field strength used, and at which timepoint the follow-up took place. In a recent study deploying T2*-weighted and SWI sequences (1,5T or 3T), the prevalence was as high as 90% after a mean observational period of 13,5 years [52]. Using 7T MRI this number is much higher with CMBs being found in up to 100% of patients [53].…”

Section: Cerebral Microbleedsmentioning

confidence: 99%

Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques

Laar

Sinnige

et al. 2019

Radiotherapy and Oncology

View full text Add to dashboard Cite

show abstract

Susceptibility-weighted magnetic resonance imaging of cerebrovascular sequelae after radiotherapy for pediatric brain tumors

Cited by 25 publications

References 32 publications

Cerebral microbleeds in adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiation

Cerebral microbleeds in adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiation

Radiation-induced accelerated aging of the brain vasculature in young adult survivors of childhood brain tumors

Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques

Contact Info

Product

Resources

About