Aims

Radiation-induced cavernomas (RIC) are common late toxicities in long-term survivors of malignancy following cerebral irradiation. However, the natural history of RIC is poorly described. We report the first series of long-term surveillance of RIC using modern magnetic resonance imaging (MRI) including highly sensitive susceptibility-weighted imaging (SWI). The aims of this research were to better characterise the natural history of RIC and investigate the utility of MRI-SWI for screening and surveillance.

Materials and methods

Eligibility required long-term survivors of malignancy with previous exposure to cerebral irradiation and RIC identified on MRI-SWI surveillance. The number and size of RIC were reported on Baseline MRI-SWI and last Follow-up MRI-SWI.

Results

In total, 113 long-term survivors with RIC underwent MRI-SWI surveillance; 109 (96%) were asymptomatic at the time of RIC diagnosis. The median age at cerebral irradiation was 9.3 years; the median radiotherapy dose was 50.4 Gy. The median time from cerebral irradiation to Baseline MRI-SWI was 17.9 years. On Baseline MRI-SWI, RIC multiplicity was present in 89% of patients; 34% had >10 RIC; 65% had RIC ≥4 mm. The median follow-up from Baseline MRI-SWI was 7.3 years. On Follow-up MRI-SWI, 96% of patients had multiple RIC; 62% had >10 RIC; 72% had RIC ≥4 mm. Of the 109 asymptomatic patients at RIC diagnosis, 96% remained free from RIC-related symptoms at 10 years. Only two required neurosurgical intervention for RIC; there was no RIC-related mortality.

Conclusions

RIC are commonly multiple, asymptomatic and typically increase in size and number over time. Our findings suggest that MRI-SWI for screening of RIC is unlikely to influence longer term intervention in asymptomatic cancer survivors. In the absence of neurological symptoms, assessment or monitoring of RIC are insufficient indications for MRI-SWI surveillance for long-term survivors of malignancy with past exposure to cerebral irradiation.

中文翻译：

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磁共振成像与磁敏感加权成像对放射诱发的海绵状血管瘤的筛查和监测对恶性肿瘤长期幸存者的影响的评估

宗旨

辐射诱发的海绵状血管瘤 (RIC) 是脑辐射后恶性肿瘤长期幸存者常见的晚期毒性。然而，RIC 的自然病程描述甚少。我们报告了使用现代磁共振成像 (MRI) 包括高灵敏度磁化率加权成像 (SWI) 的第一组 RIC 长期监测。本研究的目的是更好地描述 RIC 的自然病程，并研究 MRI-SWI 在筛查和监测中的效用。

材料和方法

资格要求先前暴露于脑辐射和 RIC 的长期恶性肿瘤幸存者在 MRI-SWI 监测中确定。RIC 的数量和大小在基线 MRI-SWI 和最后一次随访 MRI-SWI 上报告。

结果

总共有 113 名 RIC 长期幸存者接受了 MRI-SWI 监测；109 (96%) 人在 RIC 诊断时无症状。脑照射的中位年龄为 9.3 岁；中位放疗剂量为 50.4 Gy。从脑照射到基线 MRI-SWI 的中位时间为 17.9 年。在基线 MRI-SWI 中，89% 的患者存在 RIC 多重性；34% 有 >10 RIC；65% 的患者 RIC ≥ 4 mm。基线 MRI-SWI 的中位随访时间为 7.3 年。在随访 MRI-SWI 中，96% 的患者有多个 RIC；62% 有 >10 RIC；72% 的患者 RIC ≥ 4 mm。在 RIC 诊断时的 109 名无症状患者中，96% 的患者在 10 年内没有出现 RIC 相关症状。RIC 仅需要两次神经外科干预；没有 RIC 相关的死亡率。

结论

RIC 通常是多发的、无症状的，并且通常会随着时间的推移而增加大小和数量。我们的研究结果表明，用于筛查 RIC 的 MRI-SWI 不太可能影响对无症状癌症幸存者的长期干预。在没有神经系统症状的情况下，RIC 的评估或监测不足以作为 MRI-SWI 监测过去曾暴露于脑辐射的恶性肿瘤长期幸存者的指征。