Radiation-induced cavernomas of the brain

Abstract

The purpose of this report is to add support to the growing literature that there is a correlation between radiation and cavernomas of the brain, particularly if the radiation is received in childhood, as well as to increase awareness of this correlation in the radiology community. Retrospective review of our experience returned five patients who received radiation therapy while they were children and developed cavernomas in the irradiated tissues 3-41 years later. Cavernomas should be considered in the differential diagnosis of a hemorrhagic lesion in any patient who has received previous CNS radiation, particularly if he or she underwent radiation therapy in childhood.

Fig 1.

Case 1. A, Axial T2-weighted MR image obtained 12 years after craniospinal radiation therapy at 3 years of age for a posterior fossa medulloblastoma showing no lesion in the left temporal lobe/temporal horn. B, Axial T1-weighted and, C, fluid-attenuated inversion recovery (FLAIR) MR images obtained 15 years after the radiation therapy, showing a lobulated area of mixed signal intensity with peripheral hypointense rim (white arrow) in left medial temporal lobe/temporal horn, typical “popcorn” MR appearance of a cavernous angioma.

Fig 2.

Case 2. A, Axial T2- and, B, T1-weighted MR images obtained 3 years after involved field radiation therapy at 3 years of age for a posterior fossa ependymoma showing a large hemorrhagic, lobulated lesion of mixed signal intensity (white arrow) in left cerebellar hemisphere and vermis. Two more small cavernomas (black arrowheads) are seen in the right cerebellum. Postoperative changes (black arrow) are noted in the right cerebellum. C, Axial T2‐weighted MR image shows an area of blooming due to another small cavernoma (black arrow) in the right temporo-occipital region.

Fig 3.

Case 4. A, Axial T2-weighted MR image obtained 6 years after craniospinal radiation therapy at age 13 years for a suprasellar germinoma showing no lesion in right frontoparietal region. B, Axial T2-weighted and, C, FLAIR MR images obtained 8 years after the radiation therapy showing interval appearance a round lesion of mixed signal intensity with a fluid-fluid level and peripheral hypointense rim (black arrow) in right frontoparietal region.