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. 2025 May;7(3):e240388.
doi: 10.1148/rycan.240388.

Delayed Contrast-enhanced MRI Distinguishes Tumor from Radiation Treatment Effect

Rojine Tiffany Ariani  1 , Nzhde Agazaryan  1 , Steve Tenn  1 , Robert Chin  1 , Tania Kaprealian  1 , Ricky R Savjani  1
Affiliations

Delayed Contrast-enhanced MRI Distinguishes Tumor from Radiation Treatment Effect

Rojine Tiffany Ariani et al. Radiol Imaging Cancer. 2025 May.
No abstract available

Keywords: CNS; Head/Neck; Imaging Sequence; MR-Imaging; Radiation Effects; Radiation Therapy/Oncology; Treatment Effects.

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Conflict of interest statement

Disclosures of conflicts of interest: R.T.A. No relevant relationships. N.A. Honoraria and travel support, Brainlab Academy Lectures. S.T. No relevant relationships. R.C. No relevant relationships. T.K. Honoraria, Brainlab. R.R.S. Associate editor, Radiology: Imaging Cancer.

Figures

Images in a 65-year-old male patient with right parotid squamous cell carcinoma who underwent right parotidectomy with adjuvant radiation therapy (RT). (A) RT was administered at a dose of 50.4 Gy in 28 fractions, with a boost of 14.4 Gy in eight fractions. The neural foramina and brainstem received between 30 and 60 Gy. Twenty months after RT, the patient developed right cranial nerve (CN) V1–3 sensory loss, CN VII paralysis, and diplopia. (B) Axial contrast-enhanced T1-weighted MR image revealed abnormal enhancement of the right pons, CN V, and cavernous sinus, concerning for recurrence versus radionecrosis or treatment effect (white arrows). (C) MRI-based contrast clearance analysis was subsequently performed to calculate treatment assessment response maps for further characterization, demonstrating both contrast material accumulation or treatment effect (red arrows) and contrast material clearance or recurrent tumor (blue arrows). Based on these mixed findings, a multidisciplinary decision was made to initiate immunotherapy alone with follow-up imaging to monitor treatment response. After the patient was administered four cycles of cemiplimab, (D) axial contrast-enhanced T1-weighted MR image revealed substantial improvement of abnormal enhancement and resolving treatment-related changes (green arrows). Con = contrast, MPRAGE = magnetization-prepared rapid acquisition gradient-echo.
Images in a 65-year-old male patient with right parotid squamous cell carcinoma who underwent right parotidectomy with adjuvant radiation therapy (RT). (A) RT was administered at a dose of 50.4 Gy in 28 fractions, with a boost of 14.4 Gy in eight fractions. The neural foramina and brainstem received between 30 and 60 Gy. Twenty months after RT, the patient developed right cranial nerve (CN) V1–3 sensory loss, CN VII paralysis, and diplopia. (B) Axial contrast-enhanced T1-weighted MR image revealed abnormal enhancement of the right pons, CN V, and cavernous sinus, concerning for recurrence versus radionecrosis or treatment effect (white arrows). (C) MRI-based contrast clearance analysis was subsequently performed to calculate treatment assessment response maps for further characterization, demonstrating both contrast material accumulation or treatment effect (red arrows) and contrast material clearance or recurrent tumor (blue arrows). Based on these mixed findings, a multidisciplinary decision was made to initiate immunotherapy alone with follow-up imaging to monitor treatment response. After the patient was administered four cycles of cemiplimab, (D) axial contrast-enhanced T1-weighted MR image revealed substantial improvement of abnormal enhancement and resolving treatment-related changes (green arrows). Con = contrast, MPRAGE = magnetization-prepared rapid acquisition gradient-echo.
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