title: Mechanisms of post-radiation injury: cerebral microinfarction not a significant factor.
abstract: Post-radiation leukoencephalopathy is characterized by cognitive impairment and white matter alternations on imaging. Cerebral small vessel disease (SVD) is one of several suggested etiologies. Cerebral microinfarction (CMI) is a recently described marker of SVD. We sought to examine the rate of CMI as a biomarker of ongoing ischemia among patients who underwent brain radiotherapy (RT). 110 patients treated with RT for primary or metastatic brain tumors were enrolled. A total of 685 brain MRI tests performed 1-108 months post-radiation were examined. The annual incidence of CMI was calculated. Only 2 definite CMI were found (2/685, 0.3 %). The calculated annual incidence of CMI was 0.11. This incidence is similar to the normal population, and lower than the reported incidence in patients with intracerebral hemorrhage or cognitive impairment. CMI incidence in patients treated with brain RT is similar to the general population. This finding suggests that post-radiation leukoencephalopathy and cognitive impairment are not due to active SVD solely but rather secondary to other causes such as inflammation, metabolic or direct cell damage.
authors.affiliation: Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel.
authors.forename: J A
authors.initials: JA
authors.lastname: Molad
authors.affiliation: Neuro-oncology Service, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: D T
authors.initials: DT
authors.lastname: Blumenthal
authors.affiliation: Neuro-oncology Service, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: F
authors.initials: F
authors.lastname: Bokstein
authors.affiliation: Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Findler
authors.affiliation: Neuro-oncology Service, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikwa, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Finkel
authors.affiliation: Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: N M
authors.initials: NM
authors.lastname: Bornstein
authors.affiliation: Neuro-oncology Service, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikwa, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Yust-Katz
authors.affiliation: Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel. eitanman1@gmail.com.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. eitanman1@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Auriel
mesh_terms: D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D059345:Cerebral Small Vessel Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies
keywords: Cerebral microinfarct; Post-radiation leukoencephalopathy; Small vessel disease