title: Magnetic resonance imaging patterns of treatment-related toxicity in the pediatric brain: an update and review of the literature.
abstract: Treatment-related neurotoxicity is a potentially life-threatening clinical condition that can represent a diagnostic challenge. Differentiating diagnoses between therapy-associated brain injury and recurrent disease can be difficult, and the immediate recognition of neurotoxicity is crucial to providing correct therapeutic management, ensuring damage reversibility. For these purposes, the knowledge of clinical timing and specific treatment protocols is extremely important for interpreting MRI patterns. Neuroradiologic findings are heterogeneous and sometimes overlapping, representing the compounding effect of the different treatments. Moreover, MRI patterns can be acute, subacute or delayed and involve different brain regions, depending on (1) the mechanism of action of the specific medication and (2) which brain regions are selectively vulnerable to specific toxic effects. This review illustrates the most common radiologic appearance of radiotherapy, chemotherapy and medication-associated brain injury in children, with special focus on the application of advanced MRI techniques (diffusion, perfusion and proton spectroscopy) in the diagnosis of the underlying processes leading to brain toxicity.
authors.affiliation: Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy. camilla.rossiespagnet@gmail.com.
authors.forename: Maria Camilla
authors.initials: MC
authors.lastname: Rossi Espagnet
authors.affiliation: Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.|NESMOS Department, Sant' Andrea Hospital, Sapienza University, Via di Grottarossa 1035, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasquini
authors.affiliation: Enterprise Risk Management, Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Napolitano
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cacchione
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Mastronuzzi
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Caruso
authors.affiliation: Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tomà
authors.affiliation: Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Longo
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*; D020258:Neurotoxicity Syndromes / Q000000981:diagnostic imaging*
keywords: Adverse effects; Anti-neoplastic therapy; Brain; Children; Magnetic resonance imaging; Neuroradiology; Toxicity