Rocha Pedro H P, Reali Raphael M, Decnop Marcos, Souza Soraia A, Teixeira Lorine A B, Júnior Ademar Lucas, Sarpi Maíra O, Cintra Murilo B, Pinho Marco C, Garcia Marcio R T
From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.).
Radiographics. 2022 May-Jun;42(3):806-821. doi: 10.1148/rg.210150. Epub 2022 Mar 18.
Whether used as a single modality or as part of a combined approach, radiation therapy (RT) plays an essential role in the treatment of several head and neck malignancies. Despite the improvement in radiation delivery techniques, normal structures in the vicinity of the target area remain susceptible to a wide range of adverse effects. Given their high incidence, some of these effects are referred to as expected postradiation changes (eg, mucositis, sialadenitis, and edema), while others are considered true complications, meaning they should not be expected and can even represent life-threatening conditions (eg, radionecrosis, fistulas, and radiation-induced neoplasms). Also, according to their timing of onset, these deleterious effects can be divided into four groups: acute (during RT), subacute (within weeks to months), delayed onset (within months to years), and very delayed onset (after several years).The authors provide a comprehensive review of the most important radiation-induced changes related to distinct head and neck sites, focusing on their typical cross-sectional imaging features and correlating them with the time elapsed after treatment. Radiologists should not only be familiar with these imaging findings but also actively seek essential clinical data at the time of interpretation (including knowledge of the RT dose and time, target site, and manifesting symptoms) to better recognize imaging findings, avoid pitfalls and help guide appropriate management. RSNA, 2022.
无论是作为单一治疗方式还是作为综合治疗方法的一部分，放射治疗（RT）在多种头颈部恶性肿瘤的治疗中都发挥着重要作用。尽管放射治疗技术有所改进，但靶区附近的正常组织仍易受到多种不良反应的影响。鉴于这些影响的高发生率，其中一些被称为预期的放疗后改变（如粘膜炎、涎腺炎和水肿），而其他则被视为真正的并发症，这意味着它们不应被预期，甚至可能代表危及生命的情况（如放射性坏死、瘘管和放射诱导的肿瘤）。此外，根据其发病时间，这些有害影响可分为四组：急性（放疗期间）、亚急性（数周至数月内）、延迟发作（数月至数年内）和非常延迟发作（数年后）。作者对与不同头颈部部位相关的最重要的放射诱导改变进行了全面综述，重点关注其典型的横断面成像特征，并将它们与治疗后经过的时间相关联。放射科医生不仅应熟悉这些影像学表现，还应在解读时积极寻求重要的临床资料（包括放疗剂量和时间、靶区部位以及表现出的症状等知识），以便更好地识别影像学表现，避免陷阱并帮助指导适当的管理。RSNA，2022年。
