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Imaging Findings After Radiotherapy to the Pelvis

¹ Department of Diagnostic Radiology, #57, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009.
² Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009.

View larger version (159K): [in a new window]   Fig. 1A. —30-year-old woman with cervical cancer. Frontal (A) and lateral (B) conventional radiographs of pelvis show typical portal used to treat cervical cancer.

View larger version (136K): [in a new window]   Fig. 1B. —30-year-old woman with cervical cancer. Frontal (A) and lateral (B) conventional radiographs of pelvis show typical portal used to treat cervical cancer.

View larger version (133K): [in a new window]   Fig. 2. —CT scan of pelvis of 43-year-old woman who presented with massive hematuria; she had been treated for stage IIB cervical cancer with definitive radiation therapy to pelvis 2 years earlier. Results of cystoscopy and biopsy indicated radiation-induced hemorrhagic cystitis that eventually required cystectomy. CT scan of pelvis obtained after clot removal reveals air and high-density fluid in bladder compatible with imaging appearance of blood. Increased perirectal and perivesical fat is due to radiation.

View larger version (109K): [in a new window]   Fig. 3A. —80-year-old man who had been treated for prostate cancer with radiation therapy. Excretory urogram shows bilateral hydronephrosis and left-sided hydroureter.

View larger version (84K): [in a new window]   Fig. 3B. —80-year-old man who had been treated for prostate cancer with radiation therapy. Left-sided retrograde pyelogram shows narrowing of distal ureter attributable to fibrosis.

View larger version (134K): [in a new window]   Fig. 4A. —31-year-old woman with stage IB cervical cancer treated 2 years earlier with 40-Gy dose of whole-pelvis and intracavitary radiation. Since therapy, patient had experienced long history of gastrointestinal complaints, including weight loss, diarrhea, and recurrent bowel obstruction. Small-bowel series shows small-bowel loops with thickened folds (arrows) in pelvis related to chronic radiation enteritis.

View larger version (148K): [in a new window]   Fig. 4B. —31-year-old woman with stage IB cervical cancer treated 2 years earlier with 40-Gy dose of whole-pelvis and intracavitary radiation. Since therapy, patient had experienced long history of gastrointestinal complaints, including weight loss, diarrhea, and recurrent bowel obstruction. CT scan also shows radiation-related thickening of bowel wall (straight arrow) and presacral soft tissues (curved arrows).

View larger version (91K): [in a new window]   Fig. 5. —43-year-old woman treated 2 years earlier for cervical cancer. Barium enema reveals widening of presacral space (double-headed arrow) and minimal narrowing of rectosigmoid.

View larger version (175K): [in a new window]   Fig. 6A. —60-year-old woman treated 2 years earlier for cervical cancer with definitive radiation. Baseline CT scan obtained at staging shows normal rectosigmoid.

View larger version (148K): [in a new window]   Fig. 6B. —60-year-old woman treated 2 years earlier for cervical cancer with definitive radiation. CT scan (B) and barium enema (C) obtained 3 years after A show rectosigmoid ulceration (arrow) that proved to be benign.

View larger version (96K): [in a new window]   Fig. 6C. —60-year-old woman treated 2 years earlier for cervical cancer with definitive radiation. CT scan (B) and barium enema (C) obtained 3 years after A show rectosigmoid ulceration (arrow) that proved to be benign.

View larger version (143K): [in a new window]   Fig. 7. —40-year-old woman who had been treated for cervical cancer. Double-contrast barium enema shows narrowing and contour irregularity of redundant transverse colon (arrow), which had been included in radiation field during therapy.

View larger version (89K): [in a new window]   Fig. 8A. —52-year-old woman who received 60-Gy whole-pelvis radiation and 15-Gy intracavitary radiation therapy for cervical cancer. Baseline barium enema obtained before therapy shows normal rectosigmoid.

View larger version (100K): [in a new window]   Fig. 8B. —52-year-old woman who received 60-Gy whole-pelvis radiation and 15-Gy intracavitary radiation therapy for cervical cancer. Barium enema obtained approximately 6 months after therapy reveals ulcerated stricture of rectosigmoid and widening of presacral space. Note clips in region of cervix.

View larger version (101K): [in a new window]   Fig. 9. —62-year-old woman treated with definitive radiation therapy 20 years earlier for stage IIB cervical cancer. Barium enema shows complex fistulas (arrows), including rectovaginal and rectovesical fistulas. b = bladder, v = vagina.

View larger version (111K): [in a new window]   Fig. 10. —Barium enema of 65-year-old woman treated for endometrial cancer with radiation 1 year earlier reveals marked narrowing and irregularity of rectum because of radiation proctitis.

View larger version (120K): [in a new window]   Fig. 11. —43-year-old man treated for rectal cancer. Coronal T1-weighted MR image of pelvis shows abrupt linear change in marrow signal in iliac bones bilaterally with fatty marrow inferiorly (arrows) corresponding to treatment portal.

View larger version (107K): [in a new window]   Fig. 12A. —76-year-old woman treated 10 years earlier for stage IB cervical cancer. Conventional radiograph of pelvis shows subcapital fracture of right hip.

View larger version (101K): [in a new window]   Fig. 12B. —76-year-old woman treated 10 years earlier for stage IB cervical cancer. Conventional radiograph of pelvis obtained 2 years after A shows right hip replacement and subcapital fracture of left hip. Sacral and ilial radiation changes are also apparent.

View larger version (116K): [in a new window]   Fig. 13A. —73-year-old woman treated for cervical cancer 2 years earlier with radiation therapy. Radiograph of pelvis before radiation therapy shows normal bone.

View larger version (151K): [in a new window]   Fig. 13B. —73-year-old woman treated for cervical cancer 2 years earlier with radiation therapy. Conventional radiograph of pelvis after therapy reveals multiple insufficiency fractures (arrows).

View larger version (116K): [in a new window]   Fig. 13C. —73-year-old woman treated for cervical cancer 2 years earlier with radiation therapy. CT scans of pelvis also reveal fractures of sacrum, left iliac bone, and inferior pubic rami (arrows).

View larger version (126K): [in a new window]   Fig. 13D. —73-year-old woman treated for cervical cancer 2 years earlier with radiation therapy. CT scans of pelvis also reveal fractures of sacrum, left iliac bone, and inferior pubic rami (arrows).

View larger version (151K): [in a new window]   Fig. 14A. —63-year-old woman treated with radiation therapy for stage IIA cervical cancer 25 years earlier; she had been involved in motor vehicle accident 1 month before imaging and sustained known pubic fracture. Axial T1-weighted MR images of pelvis before (A) and after (B) administration of gadolinium show abnormal signal in right pubis (solid arrow), which biopsy results confirmed to be radioosteonecrosis. Note hematoma located posteriorly (open arrow).

View larger version (163K): [in a new window]   Fig. 14B. —63-year-old woman treated with radiation therapy for stage IIA cervical cancer 25 years earlier; she had been involved in motor vehicle accident 1 month before imaging and sustained known pubic fracture. Axial T1-weighted MR images of pelvis before (A) and after (B) administration of gadolinium show abnormal signal in right pubis (solid arrow), which biopsy results confirmed to be radioosteonecrosis. Note hematoma located posteriorly (open arrow).

View larger version (127K): [in a new window]   Fig. 15A. —52-year-old woman treated with 40-Gy external beam therapy to pelvis and intracavitary therapy 14 years earlier for stage IIB cervical cancer. Enterovaginal fistula was complication of therapy. Conventional radiograph of pelvis shows lytic destruction of right iliac bone.

View larger version (143K): [in a new window]   Fig. 15B. —52-year-old woman treated with 40-Gy external beam therapy to pelvis and intracavitary therapy 14 years earlier for stage IIB cervical cancer. Enterovaginal fistula was complication of therapy. CT scan shows bony destruction and surrounding soft-tissue mass. Biopsy revealed high-grade sarcoma compatible with radiation-induced sarcoma.

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