Article Figures & Data
Figures
- FIG 1.
A 36-year-old man with a history of metastatic melanoma treated with 40 Gy of whole-brain radiation therapy and a partial brain boost of 10 Gy presented with headache, seizure, visual disturbance, and speech impairment. A and B, Cortical edematous changes with gyriform enhancement is seen in the left temporal and occipital lobes. C, SWI shows no convincing focal WM hypointensity. D and E, DWI and ADC show no restricted diffusion. He completely recovered.
- FIG 2.
A 62-year-old man with a history of lymphoplasmacytic lymphoma treated with resection and 40 Gy of whole-brain radiation therapy presented with seizure, left hemiparesis, and speech impairment. A and B, A FLAIR hyperintense region associated with gyriform enhancement and subcortical WM edematous change in the right frontal and parietal lobes. C and D, DWI and SWI show restricted diffusion (ADC not shown) and SWI hypointensity in the same area (yellow arrow). E, DSC MR imaging shows an increase in rCBV in the corresponding area (white arrow). The patient recovered incompletely, with remaining left hemiparesis.
Tables
Total Completely Recovered Incompletely Recovered P Value No. of patients 20 11 9 NA Sex (female/total) 5/20 2/11 3/9 .62 Age (yr) 48 (36–55) 44 (35–48) 55 (51–63) .028 Time since the completion of RT (yr) 10.5 (5–20) 12 (7–20) 8 (5–14) .62 Period of follow-up (mo) 8.5 (1–18) 1 (1–2) 18 (10–22) .002 Surgical resection 15/20 8/11 7/9 1 Concurrent chemotherapy at the first diagnosis 16/20 9/11 7/9 1 Episode of migraine at the diagnosis 12/20 8/11 4/9 .36 Steroid treatment 11/20 3/11 8/9 .01 Antiepileptic or antimigraine drugs 12/20 7/11 5/9 1 Antiangiogenic drug 1/20 1/11 0/9 1 Recurrent episode of SMART syndrome 11/20 6/11 5/9 1 Note:—RT indicates radiation therapy; NA, not applicable.
↵a Values were described as median (interquartile range).
Total Completely Recovered Incompletely Recovered P Value Gyriform enhancement 20/20 11/11 9/9 1 Cortical edematous change 19/20 11/11 8/9 .45 Restricted diffusion (high DWI and low ADC) 4/20 0/11 4/9 .026 Linear subcortical WM SWI (17)/T2*WI (3) hypointensity 11/20 3/11 8/9 .01 Increased rCBV (DSC MR imaging) 4/6 2/3 2/3 1 Complication of brain irradiation (cavernoma or microhemorrhage) 13/20 8/11 5/9 .64 Subcortical WM edematous change 9/20 2/11 7/9 .022
