Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan.
Biol Blood Marrow Transplant. 2012 Jul;18(7):1090-8. doi: 10.1016/j.bbmt.2011.12.582. Epub 2011 Dec 23.
Radiation-induced cavernous hemangioma (RICH) is a late complication of cerebral radiation therapy. Long-term survivors of hematopoietic stem cell transplantation (HSCT) who underwent radiation therapy could be at increased risk for RICH. We investigated records of 68 patients who underwent HSCT during childhood or adolescence and were assessed by magnetic resonance imaging (MRI), including T2*-weighted imaging of the brain, annually for 5 years over a range of 6 to 29 years after HSCT. We developed a scoring and grading system for RICH to monitor the process and the progress of radiologic changes. Among the 68 patients investigated, 28 (41.2%) were diagnosed with CH. All 28 patients had received total body irradiation as a conditioning treatment for HSCT and/or cranial radiation therapy before HSCT as part of the treatment of their primary disease. RICH was diagnosed in none of the patients who did not receive radiation (n = 19), in 46.2% of those who received 6 to 12 Gy (n = 39), and in all of those who received 18 to 36 Gy (n = 10). Total RICH scores were correlated with higher radiation doses. Careful and long-term evaluation with MRI, including T2*-weighted imaging, is necessary for HSCT recipients who received radiation therapy before and/or during HSCT.
放射性海绵状血管畸形（RICH）是脑放射治疗的一种晚期并发症。接受过造血干细胞移植（HSCT）且接受过放射治疗的长期幸存者可能会增加 RICH 的风险。我们调查了 68 名在儿童或青少年时期接受过 HSCT 并通过磁共振成像（MRI）进行评估的患者的记录，包括脑 T2*-加权成像，每年进行一次，范围为 6 至 29 年，时间跨度为 HSCT 后。我们制定了 RICH 的评分和分级系统，以监测放射变化的过程和进展。在接受调查的 68 名患者中，28 名（41.2%）被诊断为 CH。所有 28 名患者均接受过全身照射作为 HSCT 的预处理，并且/或者在 HSCT 之前接受过颅放射治疗，作为其原发性疾病治疗的一部分。在未接受放射治疗的患者（n=19）中无一例诊断为 RICH，在接受 6 至 12 Gy 照射的患者中（n=39），有 46.2%的患者被诊断为 RICH，在接受 18 至 36 Gy 照射的患者中（n=10），所有患者均被诊断为 RICH。总 RICH 评分与更高的辐射剂量相关。对于接受过放射治疗的 HSCT 受者，在 HSCT 前和/或期间需要进行 MRI 包括 T2*-加权成像的仔细和长期评估。
