Presentation
Known for ovarian carcinoma with cerebral metastases. Two MRI exams are shown below before and after cranial radiation therapy.
Patient Data
There are two intra-axial lesions at the grey-white matter junction in the right parietal region (16 mm) and left temporo-occipital region (25 mm). They elicit an iso-to low signal to the cortical grey matter on T1, iso-to high signal on T2 and FLAIR with restricted diffusion mainly peripherally. The postcontrast sequences show a vivid heterogeneous enhancement. Surrounding vasogenic edema is noted with a mass effect on the trigone of the left lateral ventricle. Findings in keeping with cerebral metastases.
MRI exam performed after cranial radiation therapy (6 months later) shows:
- complete regression of the cerebral metastases with however persistence of a small area of gliosis in the right parietal region
- confluent hyperintensities on T2/FLAIR of the periventricular white matter, corona radiata and centra semiovale sparing the U-fibers, in keeping with a radiation-induced leukoencephalopathy
- punctate areas of high signal on FLAIR and T2 with restricted diffusion are noted in the cerebellum and centra semiovale of ischemic nature, suggestive of radiation-induced vasculopathy
Case Discussion
MRI features suggestive of radiation-induced leukoencephalopathy with vasculopathy in a patient treated with cranial radiation therapy for cerebral metastases from ovarian carcinoma.
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