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Magnetic resonance imaging patterns of treatment-related toxicity in the pediatric brain: an update and review of the literature

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Abstract

Treatment-related neurotoxicity is a potentially life-threatening clinical condition that can represent a diagnostic challenge. Differentiating diagnoses between therapy-associated brain injury and recurrent disease can be difficult, and the immediate recognition of neurotoxicity is crucial to providing correct therapeutic management, ensuring damage reversibility. For these purposes, the knowledge of clinical timing and specific treatment protocols is extremely important for interpreting MRI patterns. Neuroradiologic findings are heterogeneous and sometimes overlapping, representing the compounding effect of the different treatments. Moreover, MRI patterns can be acute, subacute or delayed and involve different brain regions, depending on (1) the mechanism of action of the specific medication and (2) which brain regions are selectively vulnerable to specific toxic effects. This review illustrates the most common radiologic appearance of radiotherapy, chemotherapy and medication-associated brain injury in children, with special focus on the application of advanced MRI techniques (diffusion, perfusion and proton spectroscopy) in the diagnosis of the underlying processes leading to brain toxicity.

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Authors and Affiliations

  1. Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy

    Maria Camilla Rossi Espagnet, Luca Pasquini & Daniela Longo

  2. NESMOS Department, Sant’ Andrea Hospital, Sapienza University, Via di Grottarossa 1035, Rome, Italy

    Luca Pasquini

  3. Enterprise Risk Management, Medical Physics Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Antonio Napolitano

  4. Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Antonella Cacchione, Angela Mastronuzzi & Roberta Caruso

  5. Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Paolo Tomà

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  1. Maria Camilla Rossi Espagnet
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  2. Luca Pasquini
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Correspondence to Maria Camilla Rossi Espagnet.

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Rossi Espagnet, M.C., Pasquini, L., Napolitano, A. et al. Magnetic resonance imaging patterns of treatment-related toxicity in the pediatric brain: an update and review of the literature. Pediatr Radiol 47, 633–648 (2017). https://doi.org/10.1007/s00247-016-3750-4

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  • DOI: https://doi.org/10.1007/s00247-016-3750-4

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