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Nebenwirkungen nach Strahlentherapie in der Bildgebung

Imaging of side effects after radiation therapy

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Zusammenfassung

Hintergrund

In Abhängigkeit von der Bestrahlungslokalisation und dem Zielvolumen kommt es zu einer zwangsläufigen Mitbestrahlung des peritumoralen Normalgewebes. Abhängig vom zeitlichen Verlauf nach der Bestrahlung werden akute, subakute und chronische Reaktionen im mitbestrahlten Normalgewebe beschrieben, die sich in der Bildgebung widerspiegeln. Dabei können radiogene Gewebsschäden temporär oder dauerhaft auftreten.

Zielstellung

Der Artikel gibt einen Überblick über die wichtigsten radiologischen Zeichen radiogener Normalgewebsveränderungen in den verschiedenen Organsystemen.

Befunde

Häufige radiogene Pathologien in der Bildgebung sind Pneumonitis, Blut-Hirn-Schrankenstörung, Radionekrose im Hirnparenchym, radiogene Lebererkrankung, Mukositis, Kolitis, Osteitis, Osteoradionekrose und Myositis. Eine Kombination mit einer Chemotherapie oder Immuntherapie kann die radiogene Normalgewebsreaktion noch deutlich verstärken.

Empfehlung für die radiologische Nachsorge

Die wichtigste Differenzialdiagnose zur radiogenen Normalgewebsreaktion stellt das posttherapeutische Tumorrezidiv dar. Je nach Tumorbiologie und Bestrahlungstechnik treten die Tumorrezidive nach einer Radiotherapie im unterschiedlichen zeitlichen Intervall auf. Dies sollte entsprechend den Tumorleitlinien durch ein engmaschiges Nachsorgeintervall abgedeckt werden. Für den sicheren Ausschluss eines Tumorrezidivs ist es erforderlich, neben der Bildgebung auch das klinische Erscheinungsbild des Patienten miteinzubeziehen. Hierbei sollte der Radiologe typische Erscheinungsbilder radiogener Normalgewebsreaktionen in der Bildgebung erkennen, um Fehlinterpretationen bei Follow-up-Untersuchungen zu vermeiden.

Abstract

Background

Peritumoral normal tissue is inevitably also irradiated during radiotherapy, depending on the location and size of the target volume as well as the cumulative dose. Depending on the temporal course after irradiation acute, subacute, and chronic alterations are described in co-irradiated normal tissue that can be detected by imaging. Radiation damage can be transient or persistent.

Objective

This article gives an overview of the most important signs of radiation-induced radiogenic alterations to tissue in various organ systems.

Findings

Frequent radiation-induced tissue alterations found by imaging are pneumonitis, disturbance of the blood-brain barrier, radionecrosis of brain tissue, radiogenic liver damage, mucositis, colitis, osteitis, osteoradionecrosis and myositis. The combination with systemic chemotherapy or immunotherapy can increase the severity of radiogenic reactions of normal tissue.

Recommendations for aftercare

The most important differential diagnosis for radiogenic alterations to normal tissue is post-therapeutic tumor recurrence. Besides typical latency periods, location and matching with the radiation field are important differentiation criteria, depending on the tumor biology and the radiation technique. The follow-up schedule should follow the current guidelines and the clinical condition of the patient should be additionally considered. The radiologist needs to be familiar with the typical imaging morphology of radiogenic tissue changes to avoid false interpretation during follow-up investigations.

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Authors and Affiliations

  1. Radiologische Klinik, Abt. für Radioonkologie u. Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    T. Welzel &  J. M. Tanner

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Correspondence to T. Welzel.

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T. Welzel und J.M. Tanner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Welzel, T., Tanner, J.M. Nebenwirkungen nach Strahlentherapie in der Bildgebung. Radiologe 58, 754–761 (2018). https://doi.org/10.1007/s00117-018-0412-6

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