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Radiation-Induced Temporal Lobe Changes

CT and MR Imaging Characteristics

¹ Department of Diagnostic Radiology, Singapore General Hospital, Outram Rd., 169608 Singapore.
² Department of Radiology, University of North Carolina at Chapel Hill, 3323 Old Infirmary Bldg., CB 7510, Chapel Hill, NC 27599-7510.

View larger version (156K): [in a new window]   Fig. 1. —55-year-old man with tumor recurrence showing intracerebral invasion. Coronal enhanced T1-weighted spin-echo MR image shows tumor recurrence (asterisk) associated with large extradural mass and invasion of right temporal lobe (arrow). Intracranial tumor recurrence is usually located in extradural space but may invade brain in more advanced cases.

View larger version (161K): [in a new window]   Fig. 2A. —51-year-old man with radiation-induced bilateral temporal lobe changes. Axial enhanced CT scan shows patchy enhancement and edema in right temporal lobe. Left temporal lobe is affected to lesser degree.

View larger version (167K): [in a new window]   Fig. 2B. —51-year-old man with radiation-induced bilateral temporal lobe changes. Axial enhanced T1-weighted spin-echo MR image shows extensive lesion in right temporal lobe (asterisk). Note preferential gray matter lesion in left temporal lobe (arrow) that may be seen in patients with nasopharyngeal carcinoma treated with radiation therapy.

View larger version (164K): [in a new window]   Fig. 2C. —51-year-old man with radiation-induced bilateral temporal lobe changes. Coronal enhanced T1-weighted spin-echo MR image shows gray matter lesion (white arrow) in left lobe. Note large lesion (asterisk) in right temporal lobe, white matter edema (star), and shift of midline (black arrow). Also note intracerebral lesions note associated with nasopharyngeal or extradural mass.

View larger version (138K): [in a new window]   Fig. 3A. —49-year-old man with radiation-induced unilateral temporal lobe changes. Axial enhanced CT scan obtained during assessment of nasopharynx shows ill-defined contrast enhancement in left temporal lobe.

View larger version (137K): [in a new window]   Fig. 3B. —49-year-old man with radiation-induced unilateral temporal lobe changes. Axial enhanced CT scan of brain obtained 1 hr after A shows solid pattern of enhancement (arrow).

View larger version (159K): [in a new window]   Fig. 4. —61-year-old woman with radiation-induced bilateral temporal lobe changes. Axial enhanced CT scan shows ring enhancement in left temporal lobe (asterisk). Note solid enhancement pattern on contralateral side (star).

View larger version (155K): [in a new window]   Fig. 5A. —59-year-old man with gray and white matter lesions, resulting in subsequent cerebral atrophy. Axial enhanced T1-weighted spin-echo MR image shows right (arrowheads) and left (star) temporal lobe lesions.

View larger version (164K): [in a new window]   Fig. 5B. —59-year-old man with gray and white matter lesions, resulting in subsequent cerebral atrophy. Axial enhanced T1-weighted spin-echo MR image obtained 10 months after steroid therapy shows decrease in lesion size. Note subarachnoid space (asterisks) and onset of cerebral atrophy with temporal horn dilatation (stars). Gray matter enhancement may persist for years.

View larger version (170K): [in a new window]   Fig. 6A. —62-year-old man with chronic hematoma associated with radiation-induced temporal lobe changes. Coronal unenhanced T1-weighted spin-echo MR image shows left temporal lobe swelling (star) and low-signal-intensity curvilinear hemosiderin (arrows).

View larger version (149K): [in a new window]   Fig. 6B. —62-year-old man with chronic hematoma associated with radiation-induced temporal lobe changes. Coronal T2-weighted spin-echo MR image obtained 2 weeks after A shows better delineation of chronic hematoma (arrow) and persistent edema (E). Hemosiderin is often seen on T2-weighted spin-echo MR images in patients with moderate to extensive lesions.

View larger version (167K): [in a new window]   Fig. 7A. —49-year-old woman with bilateral radiation-induced temporal lobe changes showing subacute hemorrhage and encephalomalacia. Axial enhanced T1-weighted spin-echo MR image shows high-signal-intensity foci (arrows) in right temporal lobe. Note intermediate signals in left temporal lobe (star).

View larger version (162K): [in a new window]   Fig. 7B. —49-year-old woman with bilateral radiation-induced temporal lobe changes showing subacute hemorrhage and encephalomalacia. Axial T2-weighted spin-echo MR image shows low and high signals on right indicating blood products. Note cystic changes (star) in left temporal lobe and associated edema.

View larger version (161K): [in a new window]   Fig. 7C. —49-year-old woman with bilateral radiation-induced temporal lobe changes showing subacute hemorrhage and encephalomalacia. Coronal enhanced T1-weighted spin-echo MR image shows cystic encephalomalacia (white star) in left temporal lobe. Note inflammatory changes (black star) in sphenoid sinus and slough (arrow) in nasopharynx.

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