Radiation-induced neuritis

Last revised by Kyriacos S. Evangelou on 28 Jul 2021

Radiation-induced neuritis is a complication of radiotherapy that may present with visible changes on MRI. It is likely to be most relevant in the head and neck region. There is only scarce radiology literature on the subject and radiation-induced optic neuritis is best documented. 

When patients are irradiated for the treatment of nasopharyngeal carcinomas, the nerve most commonly affected is the hypoglossal nerve (CN XII) 2.

Radiation-induced neuritis may demonstrate thickening of the affected nerves with and T2 hyperintense signal and enhancement 1.

  • T2: hyperintense perineural signal
  • T1C+ (Gd): perineural enhancement

The main differential diagnosis is perineural spread of tumor. However, the latter usually demonstrates more nodular enhancement and is usually FDG avid on PET-scan. If accessible, biopsy of the affected site may provide a definitive answer.

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