title: Evolution of cerebral microbleeds after cranial irradiation in medulloblastoma patients.
abstract: OBJECTIVE
  To characterize the temporal and spatial pattern of cerebral microbleeds (CMBs) after cranial irradiation in patients with medulloblastoma.
  
  
  METHODS
  We retrospectively identified patients with medulloblastoma treated with craniospinal irradiation at the Massachusetts General Hospital between 1999 and 2015. Longitudinal MRI including T2*-weighted gradient-recalled echo (GRE) sequences were reviewed, and the prevalence, spatial pattern, and risk factors associated with CMBs were characterized.
  
  
  RESULTS
  We identified a total of 27 patients; 5 patients were children (median age 6.3 years) and 22 patients were adults (median age 28.8 years). CMBs were found in 67% (18/27) of patients, who were followed for a median of 4.1 years. Patients with CMBs had longer GRE follow-up time compared to those without CMBs (4.9 vs 1.7 years,p= 0.035). The median latency of the appearance of CMBs was 2.79 years (interquartile range 1.76-4.26). The prevalence of CMBs increased with each year from time of radiation therapy, and the cumulative prevalence was highest in patients age <20 years (100% cumulative prevalence, vs 59% in adult patients treated at age ≥20 years). CMBs were mostly found in lobar distribution and predominately in bilateral occipital lobes. Patients using antithrombotic medications developed CMBs at a significantly higher rate (p= 0.041).
  
  
  CONCLUSIONS
  Our data demonstrate a high prevalence of CMBs following cranial irradiation, progressively increasing with each year from time of radiation therapy.
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Duangnapa
authors.initials: D
authors.lastname: Roongpiboonsopit
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Hugo J
authors.initials: HJ
authors.lastname: Kuijf
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Andreas
authors.initials: A
authors.lastname: Charidimou
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Li
authors.initials: L
authors.lastname: Xiong
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Sergi
authors.initials: S
authors.lastname: Martinez-Ramirez
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Shih
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Corey M
authors.initials: CM
authors.lastname: Gill
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston. Dietrich.Jorg@mgh.harvard.edu.
authors.forename: Jorg
authors.initials: J
authors.lastname: Dietrich
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery; D015995:Prevalence; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents