Evolution of cerebral microbleeds after cranial irradiation in medulloblastoma patients

Roongpiboonsopit, Duangnapa, Kuijf, Hugo J., Charidimou, Andreas, Xiong, Li, Vashkevich, Anastasia, Martinez-Ramirez, Sergi, Shih, Helen A., Gill, Corey M., Viswanathan, Anand, Dietrich, Jorg


Neurology 88 (8), p. 789-796


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