Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, Germany.
Radiother Oncol. 2019 Jul;136:50-55. doi: 10.1016/j.radonc.2019.03.017. Epub 2019 Apr 11.
While survival times after treatment of medulloblastoma are increasing, little is known about radiochemotherapy (RCT)-induced cerebrovascular changes. High resolution vessel wall imaging (VWI) sequences are an emerging tool for the evaluation of cerebrovascular diseases. We performed VWI in medulloblastoma long-term survivors to screen for late sequelae of RCT.
Twenty-two pediatric medulloblastoma survivors (mean age 25.8 years (10-53 years); 16.3 years (mean) post primary RCT (range 1-45 years)) underwent 2D VWI-MRI. Vessel wall thickening, contrast enhancement and luminal narrowing were analyzed. The findings were correlated with the patients' radiation protocols.
Vessel wall changes were observed the intracranial internal carotid artery (ICA) and the vertebrobasilar circulation (VBC) in 14 of 22 patients (63.6%). In multivariate analysis, time after RCT (OR = 1.38, p < 0.05) was strongest independent predictor for development of vessel wall alterations. The dose of radiation was not a relevant predictor.
With longer follow-up time intracranial vessel wall changes are observed more frequently in medulloblastoma survivors. Thus VWI is a useful tool to monitor vessel wall alterations of cranially irradiated patients, creating the prerequisite for further treatment of late sequelae.
尽管治疗髓母细胞瘤后的存活时间在延长，但人们对放化疗（RCT）引起的脑血管变化知之甚少。高分辨率血管壁成像（VWI）序列是评估脑血管疾病的新兴工具。我们对髓母细胞瘤长期幸存者进行 VWI 检查，以筛查 RCT 的晚期后遗症。
22 名儿科髓母细胞瘤幸存者（平均年龄 25.8 岁（10-53 岁）；RCT 后 16.3 年（平均）（范围 1-45 年））接受了 2D VWI-MRI 检查。分析了血管壁增厚、对比增强和管腔狭窄。将发现与患者的放射治疗方案相关联。
在 22 名患者中的 14 名（63.6%）观察到颅内颈内动脉（ICA）和椎基底动脉循环（VBC）的血管壁变化。在多变量分析中，RCT 后时间（OR=1.38，p<0.05）是血管壁改变发展的最强独立预测因子。辐射剂量不是一个相关的预测因子。
随着随访时间的延长，髓母细胞瘤幸存者中更频繁地观察到颅内血管壁变化。因此，VWI 是监测颅照射患者血管壁改变的有用工具，为治疗晚期后遗症创造了前提。
