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The evolution of bone marrow signal changes at the skull base in nasopharyngeal carcinoma patients treated with radiation therapy

  • Head, Neck and Dental Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Background

Clival infiltration is frequently seen in nasopharyngeal carcinoma (NPC) and the resultant bone marrow signal changes (BMSC) can persist even after complete tumor response to the radiation therapy (RT). The differentiation of those residual BMSC from recurrent/persistent disease may be challenging. We performed serial analysis of the clival BMSC after RT, to define an expected temporal evolution of those signal changes during the follow-up.

Materials and methods

Serial MRI studies of 50 NPC patients (with or without initial clival infiltration) who had undergone RT were retrospectively examined. Abnormal clival BMSC and contrast enhancement (CE) were evaluated on each follow-up scan. Duration of BMSC/CE was correlated with the degree of baseline clival involvement (BCID), RT dose, and primary mass volume (PMV).

Results

Clival BMSC persisted without any evidence of recurrence, for a mean of 66.5 (max. 137) months (with accompanying CE for up to 125 months) in 26 patients with clival infiltration at diagnosis. Duration of BMSC and CE showed statistical correlations with PMW (p < 0.05), but not with RT dose or BCID. The rate of recurrence in clivus was 14%. New clival lesions that occurred within the first 12 months after RT (in six patients) did not develop recurrence suggesting radiation osteitis (12%).

Conclusion

After RT, residual clival medullary signal change/enhancement is seen in most NPC patients and can persist even years without recurrence.

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Abbreviations

BCID:

Baseline clival involvement degree

BM:

Bone marrow

BMSC:

Bone marrow signal change

CE:

Contrast enhancement

NPC:

Nasopharyngeal carcinoma

PMV:

Primary mass volume

RT:

Radiation therapy

SI:

Signal intensity

SB:

Skull base

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye/Ankara, Turkey

    Safak Parlak

  2. Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Gozde Yazici

  3. Department of Mathematical Science, RMIT University, Melbourne, Australia

    Anil Dolgun

  4. Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA

    Burce Ozgen

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  1. Safak Parlak
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  2. Gozde Yazici
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  4. Burce Ozgen
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Correspondence to Safak Parlak.

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Institutional Review Board approval was obtained (Hacettepe University Institutional Review Board GO 14/07-28).

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Written informed consent was waived by the Institutional Review Board.

Statistics and biometry

Anil Dolgun, one of the authors, has significant statistical expertise.

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Some study subjects or cohorts have been previously reported as oral presentation in ECR 2015.

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Parlak, S., Yazici, G., Dolgun, A. et al. The evolution of bone marrow signal changes at the skull base in nasopharyngeal carcinoma patients treated with radiation therapy. Radiol med 126, 818–826 (2021). https://doi.org/10.1007/s11547-021-01342-y

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  • DOI: https://doi.org/10.1007/s11547-021-01342-y

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