New insights in radiation-induced leukoencephalopathy: a prospective cross-sectional study

Abstract

RIL can be defined by clinical symptoms (subcortical frontal decline, gait apraxia, urinary incontinence) and MRI criteria (cortico-subcortical atrophy, spread FLAIR HI, T2* asignals). This condition mimics a diffuse progressive cerebral small vessel disease triggered by RT, independent of RT protocol.

Balance Impairment in Radiation Induced Leukoencephalopathy Patients Is Coupled With Altered Visual Attention in Natural Tasks

“…Symptoms may be manifested months or even decades after either cerebral RT alone or cerebral RT combined with chemotherapies (1). Cognitive impairment such as attention or memory deficits are the primary manifestations of the disease followed by balance and gait impairment and, at an advanced stage, urinary incontinence (1, 2). They have a significant impact on the patient's life, often permanently affecting his/her autonomy.…”

“…They have a significant impact on the patient's life, often permanently affecting his/her autonomy. Progressively, RIL patients may also suffer from severe dementia and total loss of autonomy (2–4). In the severe stage of RIL syndrome, patients may benefit from specific motor and cognitive re-education programs.…”

Proton therapy for selected low grade glioma patients in the Netherlands

“…However, diffusion tensor imaging is a more sensitive MRI technique, which enables early detection of microstructural changes in the white matter [58][59][60][61]. White matter lesions may represent various pathophysiological processes including degeneration and cell loss, demyelination, astrogliosis and ischemic (micro)vasculopathy [62]. The grey matter and white matter display regional differences in radiation sensitivity [63][64][65].…”

Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques

“…Higher white matter volume loss is correlated with the radiation dose and younger age at the time of radiotherapy [75]. Neurocognitive decline after radiotherapy linked to white matter hyperintensities on T2weighted MRI sequences, so-called radiation-induced leukoencephalopathy, is mostly represented by executive functions and episodic memory decline (subcortical frontal mode with information recovery deficiency), without correlation with the type of radiotherapy (focal or WBRT) [17]. In one study comparing children with ependymoma treated with proton beam radiation therapy (PBRT) or photon-based intensity-modulated radiation therapy (IMRT), more changes were observed in the proton beam group and in younger patients, which seems to be an effect of differences in relative biological effectiveness (RBE) [76,77].…”

“…To detect radiotherapy-induced changes, MRI is generally considered as the most sensitive non-invasive technique with good clinical availability. Routine MRI techniques, such as T1-weighted imaging (T1), T2-weighted imaging (T2), fluid attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE), T2*-weighted gradient echo (T2*) and susceptibility-weighted imaging (SWI) can show oedema, cerebral microbleeds (CMBs), telangiectasias, cavernomas, white matter lesions (WML), lacunar infarcts, cortical atrophy and necrosis [13][14][15][16][17][18][19]. In the last decades, advanced imaging biomarkers reflecting microvascular integrity and function, such as quantitative susceptibility mapping (QSM), DSC-based (Dynamic Susceptibility Contrast-Enhanced) vessel architectural imaging (VAI), arterial spin labelling (ASL), diffusion tensor imaging (DTI), intravoxel incoherent motion (IVIM) have emerged [20][21][22][23][24][25].…”