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Delayed radiation myelopathy: serial MR-imaging and pathology
P J Koehler1, H Verbiest, J Jager
1Department of Neurology, De Wever Hospital, Heerlen, Netherlands. u493001@vm.uci.kun.nl
Clinical Neurology and Neurosurgery
|May 1, 1996
Summary
Delayed radiation myelopathy (DRM) can occur at doses under 50 Gy, with risk factors like diabetes and fraction doses over 2 Gy increasing susceptibility. Serial MRI may aid in distinguishing DRM from other spinal cord injuries.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Delayed radiation myelopathy (DRM) is a serious complication following radiotherapy affecting the spinal cord.
- Understanding risk factors and diagnostic markers for DRM is crucial for patient management.
Observation:
- Two cases of DRM are presented, occurring 7 and 10 months post-radiation in patients treated for squamous cell carcinoma and tonsillar carcinoma.
- Both patients developed progressive myelopathy (paraparesis to quadriplegia) after receiving spinal cord doses of 46 and 49 Gy.
- Serial Magnetic Resonance (MR) scans revealed spinal cord enlargement and increased signal intensity, indicative of injury.
Findings:
- Neuropathologic examination showed necrosis, calcification, lipid-laden macrophages, and astrocyte swelling in the white matter, with vascular hyalinosis.
- Delayed radiation myelopathy can manifest at total radiation doses below 50 Gy.
- Factors such as diabetes, hypertension, and fraction doses exceeding 2 Gy appear to contribute to DRM development.
Implications:
- Serial MRI can be a valuable tool in differentiating DRM from other causes of spinal cord dysfunction.
- The findings suggest that careful consideration of fractionation schedules and patient-specific risk factors is necessary to mitigate DRM risk.
- Early identification and potential therapeutic interventions, such as coumarin therapy in one case, may influence patient outcomes.