Miura Masatomo, Nakajima Makoto, Fujimoto Akiko, Kaku Yasuyuki, Kawano Takayuki, Watanabe Masaki, Kuratsu Jun-Ichi, Ando Yukio
Department of Neurology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan; Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
J Clin Neurosci. 2017 Dec;46:129-135. doi: 10.1016/j.jocn.2017.09.008. Epub 2017 Sep 30.
Accelerated atherosclerosis of intra- or extracranial large arteries is a major cause of radiation-induced strokes. Recent development of MRI techniques has enabled detection of another important vasculopathy: microinfarcts or microbleeds after cranial irradiation. The purpose of this study was to investigate the incidence and characteristics of small vessel disease after cranial irradiation. MR images and clinical records of 102 outpatients who had undergone cranial irradiation to brain tumors were retrospectively reviewed. Only those who had undergone TWI, TWI, FLAIR, and T∗WI during follow-up were included. Small vessel disease including small subcortical infracts, microbleeds, and volume of white matter lesions were assessed on the latest MR images of each patient. Ischemic or hemorrhagic stroke during the follow-up period was also reviewed. Twelve patients (mean age at the latest MRI, 38.5years; 8men) were assessed. The total radiation dose was 52.3±9.7Gy in these patients, 9 of whom received whole brain irradiation. Small subcortical infarcts (mean 2.3) were detected in 8 patients, microbleeds (mean 19.4) were detected in 11, and white matter lesion volume was 38.3±11.6ml. During the follow-up period of 19.8±9.7years, 5 patients experienced stroke (4 lacunar, 1 hemorrhagic). These strokes occurred as long as a median 21.9 (range, 10.4-30.2) years after cranial irradiation. In conclusion, small vessel disease is not a rare complication after cranial irradiation, even in young patients. Patients after cranial irradiation should be followed up with MR imaging including a hemosiderin-sensitive sequence.
颅内或颅外大动脉的动脉粥样硬化加速是放射性中风的主要原因。MRI技术的最新发展使得能够检测到另一种重要的血管病变:颅脑照射后的微梗死或微出血。本研究的目的是调查颅脑照射后小血管疾病的发生率和特征。对102例因脑肿瘤接受颅脑照射的门诊患者的MR图像和临床记录进行回顾性分析。仅纳入在随访期间接受过TWI、TWI、FLAIR和T∗WI检查的患者。在每位患者的最新MR图像上评估包括皮质下小梗死、微出血和白质病变体积在内的小血管疾病。还回顾了随访期间的缺血性或出血性中风情况。对12例患者(最新MRI时的平均年龄为38.5岁;8例男性)进行了评估。这些患者的总辐射剂量为52.3±9.7Gy,其中9例接受了全脑照射。8例患者检测到皮质下小梗死(平均2.3个),11例检测到微出血(平均19.4个),白质病变体积为38.3±11.6ml。在19.8±9.7年的随访期间