Differentiation Between Radiation Necrosis and True Tumour Progression After Radiotherapy to Intracranial Metastases.

IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Arian Lasocki, Joseph Sia, Stephen L Stuckey
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引用次数: 0

Abstract

Differentiating between radiation necrosis and true tumour progression after radiotherapy is challenging due to overlapping imaging appearances. This review outlines useful techniques and imaging features for making this distinction, as well as potential pitfalls. Both radiation necrosis and true tumour progression commonly manifest as peripherally enhancing lesions on post-contrast T1-weighted imaging, but the enhancing rim should be thin in radiation necrosis, while more discrete nodular enhancement suggests active tumour. Other features on post-contrast MRI that suggest radiation necrosis include enhancing lesions across anatomical boundaries, clustering of enhancing lesions and a change in lesion shape. Central diffusion restriction corresponding to the central necrotic area favours radiation necrosis, but there are potential pitfalls to be aware of, including hypercellular tumours, coagulative necrosis due to bevacizumab and intra-lesional haemorrhage. Radiation necrosis typically results in small, clustered foci of magnetic susceptibility on susceptibility-sensitive sequences, and the absence of such foci should raise concern for active tumour. When uncertainty remains, ancillary techniques such as MR perfusion and amino acid PET can improve confidence. Atypical appearances of radiation necrosis can occur, for example, cystic radiation necrosis or radiation necrosis occurring after radiotherapy to adjacent structures. It is also important for the radiologist to be aware of additional factors that may increase the likelihood of either radiation necrosis or tumour necrosis or influence patient management.

颅内转移瘤放疗后放射坏死与肿瘤真正进展之间的区别
放射治疗后放射坏死和真正的肿瘤进展之间的区分是具有挑战性的,因为重叠的影像学表现。这篇综述概述了做出这种区分的有用技术和成像特征,以及潜在的缺陷。放射坏死和肿瘤进展通常在造影后的t1加权成像上表现为周围强化病变,但放射坏死的强化边缘应较薄,而更离散的结节强化提示肿瘤活动。MRI造影后提示放射性坏死的其他特征包括病灶跨越解剖边界增强、病灶聚集和病灶形状改变。与中央坏死区相对应的中央扩散限制有利于放射性坏死,但也有潜在的陷阱需要注意,包括高细胞肿瘤、贝伐单抗引起的凝固性坏死和病变内出血。放射性坏死通常会在敏感序列上导致小的、聚集的磁化灶,没有这样的灶应该引起对活动性肿瘤的关注。当不确定性仍然存在时,辅助技术如磁共振灌注和氨基酸PET可以提高信心。不典型的放射性坏死可以出现,例如,囊性放射性坏死或放疗后邻近结构发生的放射性坏死。对于放射科医生来说,了解可能增加放射性坏死或肿瘤坏死可能性或影响患者管理的其他因素也很重要。
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来源期刊
CiteScore
3.30
自引率
6.20%
发文量
133
审稿时长
6-12 weeks
期刊介绍: Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.
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