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This report discusses the radiological findings of radiation necrosis seen on MRI including areas of T1 hypointensity with more extensive T2 hyperintensity and nodular or peripheral contrast enhancement. MRS typically shows increased lactate with reduced neuroglial markers, and this modality, along with nuclear imaging, can help distinguish radiation necrosis from other more metabolically active entities.






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Radiation necrosis of the pons after radiotherapy for nasopharyngeal carcinoma: Diagnosis and treatment

Free full text article: Radiation necrosis of the pons after radiotherapy for nasopharyngeal carcinoma: Diagnosis and treatment

Abstract
We report a case of radiation necrosis in an unusual location, the pons, in a patient who had received chemoradiation for nasopharyngeal carcinoma (NPC) over one year prior to presentation. This patient presented with subacute onset of ataxic hemiparesis and slurred speech. Initial magnetic resonance imaging (MRI) studies showed two 1-2cm peripherally contrast-enhancing lesions in the pons with extensive surrounding edema. Proton magnetic resonance spectroscopy (MRS) played a key role in narrowing the differential diagnosis to radiation necrosis. The patient underwent biweekly bevacizumab therapy and has remained clinically stable with radiologic improvement of his lesion. In addition to this case, we present an overview of the use of advanced neuroimaging in distinguishing radiation necrosis of the central nervous system (CNS) from other entities as well as the role of bevacizumab in treatment.






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