INTRODUCTION Radiation-induced cavernomas (RIC) after cranial radiotherapy have an unknown risk of hemorrhage. Zabramski magnetic resonance imaging (MRI) classification is touted as being able to indicate non-radiation-induced cavernomas hemorrhage risk. The aim of our study was to assess the hemorrhage risk of RIC during long-term follow-up of childhood cancer survivors based on brain MRI examinations. PATIENTS AND METHODS We analyzed retrospectively long-term follow-up data of 36 childhood cancer survivors after initial diagnosis with acute leukemia (n = 18) or brain tumor (n = 18), all treated with cranial radiotherapy. Detected RIC in long-term follow-up brain MRI (1.5 or 3 Tesla) were classified following the Zabramski MRI classification and were categorized into "high" (Zabramski type I, II or V) or "low" (type III or IV) risk of hemorrhage. RESULTS 18 patients (50%) showed RIC with a significant relation to the original tumor entity (p = 0.023) and the cumulative radiation dose to the brain (p = 0.016): all 9 childhood cancer survivors diagnosed with medulloblastoma developed RIC. We classified RIC in only 3/36 childhood cancer survivors (8%) (1 patient with acute lymphoblastic leukemia [Zabramski type II] and 2 patients with medulloblastoma [type I and type II]) as high risk for hemorrhage, the remaining RIC were classified as Zabramski type IV with low risk for hemorrhage. None of the childhood cancer survivors with RIC showed symptomatic hemorrhages. CONCLUSIONS RIC are common late effects in childhood cancer survivors treated with cranial radiotherapy affecting half of these patients. However, only a few RIC (occurring in 8% of all reviewed childhood cancer survivors) were classified as high risk for hemorrhage and none of the childhood cancer survivors with RIC developed symptomatic hemorrhages. Thus, we conclude that RIC are low-risk findings in brain MRI and the course is mainly benign.

中文翻译：

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辐射诱发的海绵状血管瘤是否具有临床相关性？对儿童癌症幸存者进行脑磁共振成像长期随访的结果。

引言 颅脑放疗后放射诱发的海绵状血管瘤 (RIC) 有未知的出血风险。Zabramski 磁共振成像 (MRI) 分类被吹捧为能够指示非辐射引起的海绵状血管瘤出血风险。我们研究的目的是根据脑部 MRI 检查评估儿童癌症幸存者长期随访期间 RIC 的出血风险。患者和方法 我们回顾性分析了 36 名儿童癌症幸存者在初步诊断为急性白血病 (n = 18) 或脑肿瘤 (n = 18) 后的长期随访数据，所有这些幸存者均接受了颅脑放疗。在长期随访脑部 MRI（1.5 或 3 特斯拉）中检测到的 RIC 根据 Zabramski MRI 分类进行分类，并分为“高”（Zabramski I、II 或 V 型）或“低” （III 型或 IV 型）出血风险。结果 18 名患者 (50%) 显示 RIC 与原始肿瘤实体 (p = 0.023) 和大脑累积辐射剂量 (p = 0.016) 显着相关：所有 9 名被诊断患有髓母细胞瘤的儿童癌症幸存者都出现了 RIC。我们仅将 3/36 名儿童癌症幸存者 (8%)（1 名急性淋巴细胞白血病患者 [Zabramski II 型] 和 2 名髓母细胞瘤患者 [I 型和 II 型]）的 RIC 归类为高出血风险，其余 RIC 为分类为 Zabramski IV 型，出血风险低。没有任何患有 RIC 的儿童癌症幸存者表现出有症状的出血。结论 RIC 是儿童癌症幸存者中常见的晚期效应，这些幸存者接受颅脑放疗后影响了一半的患者。然而，只有少数 RIC（发生在所有被审查的儿童癌症幸存者中的 8%）被归类为出血高风险，并且 RIC 儿童癌症幸存者中没有一个出现有症状的出血。因此，我们得出结论，RIC 是脑 MRI 中的低风险发现，并且病程主要是良性的。