MRI of Carotid Angiopathy after Therapeutic Radiation

Objective Our goal was to assess whether significant secondary atherosclerotic changes from radiation can be detected on SE MR of the neck. Materials and Methods Pre- and postradiation MR scans of 16 patients with head and neck malignancies were studied randomly, independently, and blindly by two readers to determine the frequency of narrowing of the carotid arterial lumen and obliteration of the carotid space within the carotid sheath. Results Interval narrowing of either the common, internal, or external carotid artery lumen was seen in 108 of 192 (56%) of vessels evaluated on postradiation MR scans compared with preradiation studies. The differences in the grades of vessel luminal diameter were statistically significant (p < 0.05 for one reader and p < 0.0001 for the other reader). Among the 16 patients, 3 patients had vessels with a critical degree of stenosis, newly appearing on postradiation scans. Seven of 16 patients had diffuse obliteration of the planes within the carotid space. Conclusion The incidence of accelerated atherosclerosis from therapeutic radiation may be greater than expected in nonirradiated patients. Magnetic resonance scans are an effective, noninvasive method for this type of follow-up.