Manifestations of radiation toxicity in the head, neck, and spine: An image-based review. Issue 4 (August 2022)

• Record Type: Journal Article
• Authors: Carr, Carrie M; Benson, John C; DeLone, David R; Diehn, Felix E; Kim, Dong K; Ma, Daniel; Nagelschneider, Alex A; Madhavan, Ajay A; Johnson, Derek R
• Is Part Of: Neuroradiology journal. Volume 35:Issue 4(2022)
• Page Start: 427
• Page End: 436
• Publication Date: 2022-08
• Subjects: Head and neck radiation -- spine radiation -- radiation complications -- radiation-induced malignancy -- therapeutic radiation; Nervous system -- Radiography -- Periodicals; Neuroradiography -- Periodicals; Electronic journals; 616.804757
• DOI: 10.1177/19714009221096824
• Languages: English
• ISSNs: 1971-4009

Abstract

Background and purpose: Radiation therapy is an important component of treatment in patients with malignancies of the head, neck, and spine. However, radiation to these regions has well-known potential side effects, many of which can be encountered on imaging. In this manuscript, we review selected radiographic manifestations of therapeutic radiation to the head, neck, and spine that may be encountered in the practice of radiology. Methods: We conducted an extensive literature review of known complications of radiation therapy in the head, neck, and spine. We excluded intracranial and pulmonary radiation effects from our search. We selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications. Results: Based on our initial literature search and imaging database review, we selected cases of radiation-induced tumors, radiation tissue necrosis (osteoradionecrosis and soft tissue necrosis), carotid stenosis and blowout secondary to radiation, enlarging thyroglossal duct cysts, radiation myelopathy, and radiation-induced vertebral compression fractures. Conclusions: We describe the clinical and imaging features of selected sequelae of radiation therapy to the head, neck, and spine, with a focus on those with characteristic imaging findings that can be instrumental in helping to make the diagnosis. Knowledge of these entities and their imaging findings is crucial for accurate diagnosis. Not only do radiologists play a key role in early detection of these entities, but many of these entities can be misinterpreted if one is not familiar with them.