![]() ONJ can lead to painful symptoms, such as: One of those is osteonecrosis of the jaw, or ONJ, an uncommon, potentially serious complication that causes death of the jawbone tissue. These medications are typically used in patients with cancer-related conditions such as bone metastasis in prostate cancer, breast cancer, multiple myeloma, osteoporosis and Paget’s Disease. But like all medications, they carry a risk of side effects. These antiresorptive drugs, which are designed to slow the loss of bone density and promote healthy bone formation, also can limit or prevent the spread of cancer to the bones.Īntiresorptive drugs such as bisphosphonates, denosumab, alendronate (Fosamax), and zoledronic acid (Zometa) can improve a patient’s quality of life and even save their life. doi:10.1148/radiol.Patients with osteoporosis are often prescribed medications that can help prevent severe bone fractures. Radiation-induced arteritis: thickened wall with prominent enhancement on cranial MR images report of five cases and comparison with 18 cases of Moyamoya disease. Aoki S, Hayashi N, Abe O, Shirouzu I, Ishigame K, Okubo T, Nakagawa K, Ohtomo K, Araki T. Review of cranial radiotherapy-induced vasculopathy. Murphy ES, Xie H, Merchant TE, Yu JS, Chao ST, Suh JH. Read it at Google Books - Find it at Amazon Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging. Gaensler EH, Dillon WP, Edwards MS et-al. Progressive cerebral occlusive disease after radiation therapy. High-resolution MRI of radiation-induced intracranial vasculopathy. Treatment is directed at the underlying specific disease and ranges from expectant (for telangiectasias) to intensive standard management of cerebral hemorrhages and ischemic strokes.Įlective angioplasty and stenting of significant large arterial stenoses may also be appropriate for high-grade lesions 5. Vessel wall imaging can demonstrate vessel wall thickening and enhancement of the large cerebral arteries 6. radionecrosis (not purely a vasculopathy).intracranial hemorrhage (including cerebral microhemorrhages).large vessel stenosis ( moyamoya pattern).The imaging features are different depending on the manifestation and are thus discussed separately, however, it should be noted that unlike sporadic cases the distribution of changes is usually confined to the radiation field. Veins are affected less than arteries and capillaries 5. Relatively low doses tend to result in the development of capillary telangiectasias, whereas high doses have more profound effects including blood vessel wall necrosis 5.īiopsy and pathological analysis of radiation-induced telangiectasias have demonstrated deposition of perivascular hemosiderin and hemorrhage adjacent to capillary-sized telangiectasia (pre-existing dilated channels rather than proliferating vascular neoplasm) 3. This not only results in disruption of the blood-brain-barrier but also may result in local thrombosis and hemorrhage 5.įollowing repair, vessels tend to be dilated and demonstrate endothelial proliferation, basement membrane thickening and adventitial fibrosis 5. PathologyĪ number of processes occur in vessels following radiation-induced injury and are dependent on dose, however, the dominant earliest phenomenon is endothelial damage. The likelihood of complications depends on individual patient factors, including age, and the specifics of the type and dose of radiation. Radiation-induced telangiectasia and microbleeds may be asymptomatic. However, patients may present with focal neurological deficits resulting from both hemorrhagic and ischemic stroke, lacunar lesions, vascular occlusive disease including moyamoya pattern, vascular malformations, and radiation-induced necrosis. Clinical symptoms are broad and depend on the underlying vasculopathy.
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