Schlemmer H P, Liebermann D, Naser V, Van Kaick G
Research Program Radiological Diagnostics and Therapy, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany.
J Neuroradiol. 2000 Dec;27(4):253-63.
The aim of this study was to assess late effects of long-term exposure to alpha irradiation caused by paravascular Thorotrast deposits.
899 patients, who had received the radioactive contrast medium Thorotrast for angiography in the 1930s and 1940s, and 662 controls were followed-up since 1968 every two years by standardized clinical and laboratory examinations. Initially, X-ray plain films of the thorax, upper abdomen and the former injection site were performed. In selected patients the sites of paravascular Thorotrast deposits were evaluated by ultrasonography, CT and MRI.
Paravascular Thorotrast deposits were detected in 245 patients. Clinical symptoms related to deposits appeared 10 to 30 years after Thorotrast administration. The severity of symptoms depended on the location and extension of granulomas and were mainly caused by fibrosis, nerve paralysis and vascular changes. Four malignant tumors adjacent to granulomas were observed (one soft tissue sarcoma in the groin, two squamous cell carcinomas of the parotid gland and one lymphoepithelial carcinoma of the nasopharynx). MRI including MRA allowed an accurate determination of tissue damage, whereas the utility of US and CT was restricted due to strong sound attenuation and streak artefacts caused by the high X-ray absorption of Thorotrast.
Locoregional late effects of paravascular Thorotrast deposits mainly comprise radiation induced, fibrotic tissue destruction. The incidence of malignant tumors, in particular sarcomas, adjacent to deposits, however, is much lower than initially expected.
本研究旨在评估血管旁钍造影剂沉积导致的长期α射线照射的晚期效应。
对899例在20世纪30年代和40年代接受放射性造影剂钍造影剂进行血管造影的患者以及662例对照者自1968年起每两年进行一次标准化临床和实验室检查随访。最初，拍摄胸部、上腹部及先前注射部位的X线平片。对部分患者通过超声、CT和MRI评估血管旁钍造影剂沉积部位。
在245例患者中检测到血管旁钍造影剂沉积。与沉积相关的临床症状在注射钍造影剂后10至30年出现。症状的严重程度取决于肉芽肿的位置和范围，主要由纤维化、神经麻痹和血管改变引起。观察到4例肉芽肿旁恶性肿瘤（1例腹股沟软组织肉瘤、2例腮腺鳞状细胞癌和1例鼻咽淋巴上皮癌）。包括MRA在内的MRI能够准确确定组织损伤，而由于钍造影剂的高X线吸收导致的强声衰减和条纹伪影，超声和CT的效用受到限制。
血管旁钍造影剂沉积的局部晚期效应主要包括辐射诱导的纤维化组织破坏。然而，沉积旁恶性肿瘤，尤其是肉瘤的发生率远低于最初预期。
