MR Imaging of Radiation-Induced Lumbosacral Plexopathy, as a Rare Complication of Concomitant Chemo-Radiation for Cervical Cancer

Eun Taeg Hwang; Hye Min Son; Jin Young Kim; Sung Min Moon; Ho Seok Lee

doi:10.13104/imri.2020.24.1.46

Journal List > Investig Magn Reson Imaging > v.24(1) > 1144487

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Hwang, Son, Kim, Moon, and Lee: MR Imaging of Radiation-Induced Lumbosacral Plexopathy, as a Rare Complication of Concomitant Chemo-Radiation for Cervical Cancer

Case Report

iMRI 2020;24(1):46-50.

Published online: 19 January 2020

DOI: https://doi.org/10.13104/imri.2020.24.1.46

MR Imaging of Radiation-Induced Lumbosacral Plexopathy, as a Rare Complication of Concomitant Chemo-Radiation for Cervical Cancer

Eun Taeg Hwang², Hye Min Son¹, Jin Young Kim², Sung Min Moon², Ho Seok Lee³

¹Department of Radiology, Yeungnam University College of Medicine, Daegu, Korea

²Department of Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea

³Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence to: Hye Min Son, M.D. Department of Radiology, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel. +82-53-620-3340 Fax. +82-53-629-0256 E-mail: shmm11111@gmail.com

Received 9 August 20199 December 2019 Accepted 9 December 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Radiation-induced lumbosacral plexopathy (RILSP) is an uncommon complication of pelvic radiotherapy that can result in different degrees of sensory and motor deficits. An age 59 female with cervical cancer, who had received combined chemotherapy and radiation therapy two years before, presented with bilaterally symmetric lower-extremity weakness and tingling sensation. The magnetic resonance imaging showed diffuse T2 bright signal intensity and mild enhancement along the bilateral lumbosacral plexus with no space-occupying masses. RILSP was diagnosed after the exclusion of malignant and inflammatory plexopathies.

Keywords: Radiation plexopathy, Lumbosacral plexus, Radiotherapy, Magnetic resonance imaging, Cervical carcinoma

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Fig. 1.

Contrast-enhanced hip MRI two years after the completion of CCRT. Coronal MRI at the first sacral foramen level reveals bilateral, symmetric, and diffuse T2 hyperintensity of LSP on coronal FS T2WI (a, arrows). The consecutive coronal FS T2WIs in the posterior direction demonstrated extensive involvement of LSP (b, c, arrows). Also, diffuse mild enhancement of the impacted LSP at the first sacral foramen level is depicted on T1WI (d, arrows) and contrast-enhanced T1WI (e, arrows). Note the asymmetric T2 signal change (pronounced on the right side) of the bilateral piriformis muscle (f, arrows). FS = fat suppressed; LSP = lumbosacral plexus

Fig. 2.

The MR feature of the LSP before CCRT. The pre-CCRT pelvic protocol MRI (a, axial T2WI; b, oblique coronal T2WI perpendicular to the cervix) reveal normal bilateral LSP at both of the sciatic foramen (arrows). Newly defined diffuse thickening of the bilateral LSP after CCRT completion can be heightened by comparing the images acquired before and after the CCRT. LSP = lumbosacral plexus

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