Nordstrom Matthew, Felton Erin, Sear Katherine, Tamrazi Benita, Torkildson Joseph, Gauvain Karen, Haas-Kogan Daphne A, Chen Josephine, Buono Benedict Del, Banerjee Anuradha, Samuel David, Saloner David, Tian Bing, Roddy Erika, Hess Christopher, Fullerton Heather, Mueller Sabine
1 Department of Pediatrics, University of California, San Francisco, CA, USA.
2 Department of Neurology, University of California, San Francisco, CA, USA.
J Child Neurol. 2018 Apr;33(5):359-366. doi: 10.1177/0883073818756729.
Among childhood cancer survivors, increased stroke risk after cranial radiation therapy may be caused by radiation-induced arteriopathy, but limited data exist to support this hypothesis. Herein, we assess the timing and presence of cerebral arteriopathy identified by magnetic resonance angiography (MRA) after cranial radiation therapy in childhood brain tumor survivors. In a cohort of 115 pediatric brain tumor survivors, we performed chart abstraction and prospective annual follow-up to assess the presence of large vessel cerebral arteriopathy by MRA. We identified 10 patients with cerebral arteriopathy. The cumulative incidence of arteriopathy 5 years post-cranial radiation therapy was 5.4% (CI 0.6%-10%) and 10 years was 16% (CI 4.6%-26%). One patient had an arterial ischemic stroke 2.4 years post-cranial radiation therapy in the distribution of a radiation-induced stenotic artery. We conclude that large vessel arteriopathies can occur within a few years of cranial radiation therapy and can become apparent on MRA in under a year.
在儿童癌症幸存者中，颅脑放射治疗后中风风险增加可能是由放射诱导的动脉病变引起的，但支持这一假设的数据有限。在此，我们评估儿童脑肿瘤幸存者颅脑放射治疗后通过磁共振血管造影（MRA）识别的脑动脉病变的时间和存在情况。在一组115名儿科脑肿瘤幸存者中，我们进行了病历摘要和前瞻性年度随访，以通过MRA评估大血管脑动脉病变的存在情况。我们确定了10例脑动脉病变患者。颅脑放射治疗后5年动脉病变的累积发生率为5.4%（95%CI 0.6%-10%），10年时为16%（95%CI 4.6%-26%）。1例患者在颅脑放射治疗后2.4年，在一条放射诱导的狭窄动脉分布区域发生了动脉缺血性中风。我们得出结论，大血管动脉病变可在颅脑放射治疗后的几年内发生，并且在不到一年的时间内可在MRA上显现出来。
