Central nervous system changes after radiation therapy and/or chemotherapy: correlation of CT and autopsy findings

This is a restrospective correlative study of cranial computed tomography (CT) and autopsy findings in 50 patients after central nervous system radiation therapy and/or chemotherapy. Most patients had more than one posttherapy CT scan and all cases were autopsied. Twenty-six cases (52%) showed no posttherapy CT changes. In 18 cases (36%) enlargement of intracranial subarachnoid spaces and/or ventricles was seen on CT, but only two of these cases showed gross atrophy on postmortem examination; even in these, the cortex was histologically normal, suggesting that these CT changes may be reversible. In six cases a decrease in white-matter density was seen on CT. Two of these cases were histologically normal, two cases showed some white-matter rarefaction, one case contained multiple foci of white-matter and vessel well necrosis, and one case had progressive multifocal leukoencephalopathy.