Department of Diagnostic Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China.
Radiology. 2010 Jan;254(1):210-8. doi: 10.1148/radiol.09090428. Epub 2009 Dec 17.
To evaluate the temporal lobes in patients previously treated for nasopharyngeal carcinoma to provide a better understanding of delayed radiation-induced injury in the brain unaffected by the underlying tumor.
Retrospective analysis of the patient data was approved by the local ethics committee. Informed consent was waived. Magnetic resonance (MR) imaging results in patients with temporal lobe injury (TLI) after receiving radiation for nasopharyngeal carcinoma were analyzed. The appearance and change over time of white matter lesions (WMLs), contrast material-enhanced lesions, and cysts were assessed. The Mann-Whitney U test was used to compare interval time, and the chi(2) and Fisher exact tests were used to compare the pattern of TLI changes.
The study group was 124 patients (95 men, 29 women; mean age, 51.4 years) with 192 injured temporal lobes; 62 of these patients with 103 injured temporal lobes underwent follow-up MR imaging at least once (range, one to five examinations). A total of 332 injured temporal lobes were revealed. WMLs, contrast-enhanced lesions, and cysts were present on 332 (100%), 274 (82.5%), and 42 (12.7%) studies, respectively. All contrast-enhanced lesions more than 2 cm in size showed necrosis, and those 3 cm or greater formed a rim-enhanced necrotic mass. WMLs were the only lesion to occur alone, contrast-enhanced lesions were always accompanied by WMLs, and cysts were always accompanied by WMLs and contrast-enhanced lesions. Detection of cysts was significantly later than detection of WMLs and contrast-enhanced lesions (P <.01). Regression or resolution was found in 27 (28%) of 96 WMLs, 37 (39%) of 94 contrast-enhanced lesions, and one (7%) of 15 cysts.
TLI from radiation is not always an irreversible and progressive process but is one that can regress or resolve at MR imaging. In the evolution of radiation injury, WMLs are seen first and are followed by contrast-enhanced lesions, which have an increasing tendency to become necrotic with increasing size. Cysts are the least frequent manifestation and arise in the late stage of TLI.
评估先前接受鼻咽癌治疗的患者的颞叶，以更好地了解未受肿瘤影响的脑内延迟放射性损伤。
该研究经当地伦理委员会批准进行回顾性患者数据分析，且豁免了知情同意。分析接受鼻咽癌放射治疗后出现颞叶损伤（TLI）患者的磁共振成像（MR）结果。评估白质病变（WMLs）、对比增强病变和囊肿的表现和随时间的变化。采用 Mann-Whitney U 检验比较间隔时间，采用卡方检验和 Fisher 确切概率法比较 TLI 变化模式。
研究组共 124 例患者（95 例男性，29 例女性；平均年龄 51.4 岁），192 个颞叶受伤；62 例患者（103 个颞叶受伤）至少接受了一次（1 至 5 次检查）的随访 MR 成像。共显示 332 个受伤的颞叶。332 个（100%）、274 个（82.5%）和 42 个（12.7%）研究中分别显示出 WMLs、对比增强病变和囊肿。所有大于 2 cm 的对比增强病变均显示坏死，大于 3 cm 的病变形成边缘增强坏死肿块。WMLs 是唯一单独出现的病变，对比增强病变总是伴有 WMLs，而囊肿总是伴有 WMLs 和对比增强病变。囊肿的检出明显晚于 WMLs 和对比增强病变（P <.01）。96 个 WMLs 中有 27 个（28%）、94 个对比增强病变中有 37 个（39%）和 15 个囊肿中有 1 个（7%）发现消退或缓解。
放射引起的 TLI 并非总是不可逆和进行性的过程，而是在 MR 成像上可以消退或缓解。在放射性损伤的演变过程中，首先出现 WMLs，然后是对比增强病变，随着病变增大，坏死的趋势增加。囊肿是最不常见的表现，出现在 TLI 的晚期。
