title: Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort.
abstract: OBJECTIVE
  The objective of this study was to characterize the clinical features of radiation-induced cavernous malformations (RICMs).
  
  
  METHODS
  The authors retrospectively reviewed the clinical and radiological characteristics of patients with RICMs. The features of these RICMs were then compared with features of nonradiation cavernous malformations (CMs) in 270 patients.
  
  
  RESULTS
  Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median latency from radiation treatment to RICM diagnosis was 12.0 years (interquartile range 5.0-19.6 years). RICMs were always within the previous radiation port. RICMs were symptomatic at diagnosis in 46.9%, and were associated with symptomatic intracranial hemorrhage at any time in 43.8%. Older age at the time of radiation treatment and higher radiation dose were associated with shorter latency. RICMs tended to be diagnosed at a younger age than nonradiation CMs (median 31.1 vs 42.4 years, respectively; p = 0.054) but were significantly less likely to be symptomatic at the time of diagnosis (46.9% vs 65.8%, respectively; p = 0.036). RICMs were more likely to be multiple CMs than nonradiation CMs (p = 0.0002). Prospectively, the risk of symptomatic hemorrhage was 4.2% for RICMs and 2.3% for nonradiation CMs per person-year (p = 0.556). In the absence of symptoms at presentation, the risk of hemorrhage for RICMs was higher than for nonradiation CMs (4.2% vs 0.35%, respectively; p = 0.118).
  
  
  CONCLUSIONS
  In this patient population, RICMs occurred within the radiation port approximately 12 years after radiation treatment. Compared with nonradiation CMs, RICMs were more likely to occur as multiple CMs, to present at a younger age, and were at least as likely to cause symptomatic hemorrhage.
authors.affiliation: Departments of 1 Neurology and.
authors.forename: Jeremy K
authors.initials: JK
authors.lastname: Cutsforth-Gregory
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Flemming
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D055815:Young Adult
keywords: CM = cavernous malformation; GRE = gradient echo; RICM = radiation-induced CM; RIT = radiation-induced telangiectasia; SWI = susceptibility-weighted imaging; cavernous angioma; cavernous malformation; hemorrhage; mRS = modified Rankin Scale; radiation; vascular disorders