Thust Stefanie C, Blanco Esther, Michalski Antony J, Chong W K, Gaze Mark N, Phipps Kim, Mankad Kshitij
Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
J Med Imaging Radiat Oncol. 2014 Dec;58(6):683-90. doi: 10.1111/1754-9485.12232. Epub 2014 Sep 16.
Intensive postsurgical therapies have improved survival in children with primitive neuroectodermal tumour, but there is concern that the combination of chemotherapy and radiotherapy may result in a compound injury to normal brain. The purposes of this analysis were to characterise what types of imaging abnormalities occur, identify risk factors and explore how treatment-related changes may be distinguished from tumour.
One hundred fifty-three MRI studies in 14 children treated with sequential chemotherapy, hyperfractionated accelerated radiotherapy and high-dose thiotepa were retrospectively analysed at a paediatric national referral centre.
We observed 11 episodes of new focal enhancing lesions, 5 of which were transient and judged to be treatment related. In addition, 7/14 (50%) of children demonstrated moderate to severe brain volume loss featuring a leukodystrophy pattern.
Treatment-related brain MRI abnormalities occurred frequently in this series with a risk of misdiagnosis as tumour. A proportion of patients suffer generalised white matter injury, which has not been appreciated as a side effect of this particular therapy.
强化术后治疗已提高了原始神经外胚层肿瘤患儿的生存率，但人们担心化疗和放疗的联合应用可能会对正常脑组织造成复合损伤。本分析的目的是确定出现何种类型的影像异常，识别危险因素，并探讨如何将与治疗相关的变化与肿瘤区分开来。
在一家国家儿科转诊中心，对14例接受序贯化疗、超分割加速放疗和大剂量硫代磷酸三乙酯治疗的儿童的153项MRI研究进行了回顾性分析。
我们观察到11例新的局灶性强化病变，其中5例为短暂性病变，判断与治疗相关。此外，7/14（50%）的儿童表现出中度至重度脑容量减少，呈现白质营养不良模式。
在本系列研究中，与治疗相关的脑MRI异常频繁出现，存在被误诊为肿瘤的风险。一部分患者出现广泛性白质损伤，这尚未被视为这种特殊治疗的副作用。
