title: Benign ulceration as a manifestation of soft tissue radiation necrosis: imaging findings.
abstract: OBJECTIVE
  The purpose of this study was to review CT imaging findings of soft tissue mucosal ulceration in patients following radiation treatment for head and neck malignancies and to correlate these with patient outcomes.
  
  
  METHODS
  The CT examinations in 20 patients with soft tissue ulceration after radiation therapy for treatment of head and neck cancer were reviewed. External beam radiation therapy was completed between 3 and 61 months (mean, 11.5 months) before the initial diagnosis of soft tissue ulceration. In all 20 patients, the initial diagnosis was made or confirmed on CT examination.
  
  
  RESULTS
  Of the 20 ulcerations, 12 did not demonstrate enhancement, and the results of biopsy in 9 of these 12 were negative. Of the 12 nonenhancing ulcerations, biopsy was not performed in 3, but they have been followed clinically and radiologically for 15.7 months without evidence of recurrence. Of the 20 ulcerations, 8 demonstrated adjacent enhancement, and the results of a biopsy in 4 were positive for recurrent cancer and negative in 2; these 2 have been followed for 16.3 months without evidence of recurrence. Biopsy was not performed in 2 ulcerations, but they have been followed for 15.0 months without evidence of recurrence.
  
  
  CONCLUSIONS
  For soft tissue ulceration occurring after radiation treatment, if there is no enhancement or clinical evidence of recurrence, it is likely benign and follow-up without biopsy seems warranted. If the ulceration is associated with adjacent enhancement, then differentiation between radiation necrosis and recurrent tumor is difficult. In these cases, correlation with clinical examination with close interval follow-up is necessary if a biopsy is not performed.
authors.affiliation: Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. matthew.debnam@mdanderson.org
authors.forename: J M
authors.initials: JM
authors.lastname: Debnam
authors.forename: A S
authors.initials: AS
authors.lastname: Garden
authors.forename: L E
authors.initials: LE
authors.lastname: Ginsberg
mesh_terms: D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000000981:diagnostic imaging* / Q000209:etiology*; D011859:Radiography; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging* / Q000209:etiology*; D016896:Treatment Outcome; D014456:Ulcer / Q000000981:diagnostic imaging* / Q000209:etiology*