Abstract
The spectrum of clinical and pathological effects of ionizing radiation on brain and spinal cord tissue is wide and multifactorial, depending on several factors including patient’s age, cumulative irradiation dose, type of radiotherapy, and concomitant chemotherapy or radiosensitizing agents. Radiation- and chemotherapy-induced neurotoxicity poses a challenge in clinical neuroradiology as they need to be promptly recognized, being aware of patient treatment histories to avoid futile discontinuation of an effective therapy. Furthermore, long-term complications of radiation therapy such as radiation necrosis, radiation-induced leukoencephalopathy, and secondary neoplasms may impact on the patient's management and clinical outcome. Radiological techniques such as conventional and advanced MRI play a pivotal role in the recognition of these entities in their acute, subacute, and late presentation. Ionizing radiation mainly affects glial and endothelial cells, the latter being involved both in the development of parenchymal lesions, such as radiation necrosis and radiation-induced leukoencephalopathy, and in vessel damage. This chapter evaluates the current knowledge in the diagnosis of acute and delayed sequelae of radiation therapy and concomitant or adjuvant chemotherapy on brain and spinal cord, with a particular focus on radiation injury, radiation-induced vasculopathy, and SMART (Stroke-like Migraine After Radiation Therapy) syndrome.
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Abbreviations
- ADC:
-
Apparent diffusion coefficient
- BBB:
-
Blood-brain barrier
- CNS:
-
Central nervous system
- DCE:
-
Dynamic Contrast-Enhanced
- DSC:
-
Dynamic Susceptibility Contrast
- DTI:
-
Diffusion tensor imaging
- DWI:
-
Diffusion-Weighted Imaging
- HART:
-
Hyper fractionated accelerated radiotherapy
- HIF-1α:
-
Hypoxia-inducible factor 1α
- IMRT:
-
Intensity-modulated radiation therapy
- Ktrans:
-
Volume transfer constant
- MRA:
-
Magnetic resonance angiography
- MRS:
-
MR proton spectroscopy
- PET:
-
Positron emission tomography
- PsP:
-
Pseudoprogression
- PWI:
-
Perfusion-weighted Imaging
- QoL:
-
Quality of life
- RANO:
-
Response Assessment in Neuro-Oncology
- rCBF:
-
Relative cerebral blood flow
- rCBV:
-
Relative cerebral blood volume
- RN:
-
Radiation necrosis
- ROI:
-
Region of interest
- RT:
-
Radiation therapy
- SMART:
-
Stroke-like Migraine After Radiation Therapy
- SRS:
-
Stereotactic radiosurgery
- SWI:
-
Susceptibility-weighted imaging
- VEGF:
-
Vascular-endothelial growth factor
- Vp:
-
Fractional volume of the intravascular compartment (aka fractional plasma volume)
- WBRT:
-
Whole-brain radiation therapy
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Castellano, A., Anzalone, N. (2019). Radiation and Chemotherapy Induced Injury. In: Barkhof, F., Jager, R., Thurnher, M., Rovira Cañellas, A. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-61423-6_68-1
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