Brain MR findings in patients treated with particle therapy for skull base tumors

Gisela Viselner, Lisa Farina, Federica Lucev, Elena Turpini, Luca Lungarotti, Ana Bacila, Alberto Iannalfi, Emma D'Ippolito, Barbara Vischioni, Sara Ronchi, Enrico Marchioni, Francesca Valvo, Stefano Bastianello, Lorenzo Preda

Research output: Contribution to journalReview article

Abstract

Nowadays, hadrontherapy is increasingly used for the treatment of various tumors, in particular of those resistant to conventional radiotherapy. Proton and carbon ions are characterized by physical and biological features that allow a high radiation dose to tumors, minimizing irradiation to adjacent normal tissues. For this reason, radioresistant tumors and tumors located near highly radiosensitive critical organs, such as skull base tumors, represent the best target for this kind of therapy. However, also hadrontherapy can be associated with radiation adverse effects, generally referred as acute, early-delayed and late-delayed. Among late-delayed effects, the most severe form of injury is radiation necrosis. There are various underlying mechanisms involved in the development of radiation necrosis, as well as different clinical presentations requiring specific treatments. In most cases, radiation necrosis presents as a single focal lesion, but it can be multifocal and involve a single or multiple lobes simulating brain metastasis, or it can also involve both cerebral hemispheres. In every case, radiation necrosis results always related to the extension of radiation delivery field. Multiple MRI techniques, including diffusion, perfusion imaging, and spectroscopy, are important tools for the radiologist to formulate the correct diagnosis. The aim of this paper is to illustrate the possible different radiologic patterns of radiation necrosis that can be observed in different MRI techniques in patients treated with hadrontherapy for tumors involving the skull base. The images of exemplary cases of radiation necrosis are also presented.

Original languageEnglish
Pages (from-to)94
JournalInsights into Imaging
Volume10
Issue number1
DOIs
Publication statusPublished - Sep 23 2019

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Skull Base
Radiation
Necrosis
Brain
Neoplasms
Therapeutics
Radiation Injuries
Perfusion Imaging
Radiation Effects
Cerebrum
Protons
Spectrum Analysis
Radiotherapy
Carbon
Ions
Neoplasm Metastasis

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Brain MR findings in patients treated with particle therapy for skull base tumors. / Viselner, Gisela; Farina, Lisa; Lucev, Federica; Turpini, Elena; Lungarotti, Luca; Bacila, Ana; Iannalfi, Alberto; D'Ippolito, Emma; Vischioni, Barbara; Ronchi, Sara; Marchioni, Enrico; Valvo, Francesca; Bastianello, Stefano; Preda, Lorenzo.

In: Insights into Imaging, Vol. 10, No. 1, 23.09.2019, p. 94.

Research output: Contribution to journalReview article

Viselner, G, Farina, L, Lucev, F, Turpini, E, Lungarotti, L, Bacila, A, Iannalfi, A, D'Ippolito, E, Vischioni, B, Ronchi, S, Marchioni, E, Valvo, F, Bastianello, S & Preda, L 2019, 'Brain MR findings in patients treated with particle therapy for skull base tumors', Insights into Imaging, vol. 10, no. 1, pp. 94. https://doi.org/10.1186/s13244-019-0784-9
Viselner, Gisela ; Farina, Lisa ; Lucev, Federica ; Turpini, Elena ; Lungarotti, Luca ; Bacila, Ana ; Iannalfi, Alberto ; D'Ippolito, Emma ; Vischioni, Barbara ; Ronchi, Sara ; Marchioni, Enrico ; Valvo, Francesca ; Bastianello, Stefano ; Preda, Lorenzo. / Brain MR findings in patients treated with particle therapy for skull base tumors. In: Insights into Imaging. 2019 ; Vol. 10, No. 1. pp. 94.
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AB - Nowadays, hadrontherapy is increasingly used for the treatment of various tumors, in particular of those resistant to conventional radiotherapy. Proton and carbon ions are characterized by physical and biological features that allow a high radiation dose to tumors, minimizing irradiation to adjacent normal tissues. For this reason, radioresistant tumors and tumors located near highly radiosensitive critical organs, such as skull base tumors, represent the best target for this kind of therapy. However, also hadrontherapy can be associated with radiation adverse effects, generally referred as acute, early-delayed and late-delayed. Among late-delayed effects, the most severe form of injury is radiation necrosis. There are various underlying mechanisms involved in the development of radiation necrosis, as well as different clinical presentations requiring specific treatments. In most cases, radiation necrosis presents as a single focal lesion, but it can be multifocal and involve a single or multiple lobes simulating brain metastasis, or it can also involve both cerebral hemispheres. In every case, radiation necrosis results always related to the extension of radiation delivery field. Multiple MRI techniques, including diffusion, perfusion imaging, and spectroscopy, are important tools for the radiologist to formulate the correct diagnosis. The aim of this paper is to illustrate the possible different radiologic patterns of radiation necrosis that can be observed in different MRI techniques in patients treated with hadrontherapy for tumors involving the skull base. The images of exemplary cases of radiation necrosis are also presented.

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