Wang Chi-Te, Young Yi-Ho
Department of Otolaryngology, National Taiwan University Hospital of the National Taiwan University College of Medicine, 1 Chang-Te St, Taipei, Taiwan.
Eur Arch Otorhinolaryngol. 2006 Feb;263(2):135-8. doi: 10.1007/s00405-005-0964-8. Epub 2005 Jul 8.
Differentiation between cerebral radionecrosis and intracranial relapse in irradiated nasopharyngeal carcinoma (NPC) patients challenges the clinicians, especially when clinical manifestation and MRI findings are inconclusive. A 63-year-old NPC patient had intermittent dizziness and unsteady gait 3 years after irradiation. An ice water caloric test revealed absent response on the right ear, which was compatible with an enhanced lesion at the right temporal lobe on MRI scan. Furthermore, abnormal focally increased uptake over the anteriomedial aspect of the right temporal lobe was disclosed on 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET), which suggested intracranial relapse. Conversely, serological study for Epstein-Barr viral titer was within normal limits, arguing against either recurrent or metastatic NPC. Hence, thallium (Tl)-201 single photon emission computed tomography (SPECT) was subsequently conducted, which failed to demonstrate abnormal thallium accumulation in the corresponding area. Accordingly, radiation necrosis of the temporal lobe rather than intracranial relapse is considered. The patient was rather well without locoregional recurrence or distant metastasis 2 years after presentation.
区分鼻咽癌（NPC）放疗患者的脑放射性坏死和颅内复发对临床医生来说是一项挑战，尤其是当临床表现和MRI结果不明确时。一名63岁的NPC患者放疗3年后出现间歇性头晕和步态不稳。冰水试验显示右耳无反应，这与MRI扫描显示的右侧颞叶强化病变相符。此外，18氟-2-脱氧葡萄糖（FDG）正电子发射断层扫描（PET）显示右侧颞叶前内侧局部摄取异常增加，提示颅内复发。相反，EB病毒滴度的血清学研究在正常范围内，排除了复发性或转移性NPC。因此，随后进行了铊（Tl）-201单光子发射计算机断层扫描（SPECT），结果未能显示相应区域铊的异常积聚。据此，考虑为颞叶放射性坏死而非颅内复发。该患者在就诊后2年情况良好，无局部区域复发或远处转移。
