Manifestations of radiation toxicity in the head, neck, and spine: An image-based review

Carrie M. Carr, John C. Benson, David R. DeLone, Felix E. Diehn, Dong K. Kim, Daniel Ma, Alex A. Nagelschneider, Ajay A. Madhavan, Derek R. Johnson

Research output: Contribution to journalReview articlepeer-review


Background and purpose: Radiation therapy is an important component of treatment in patients with malignancies of the head, neck, and spine. However, radiation to these regions has well-known potential side effects, many of which can be encountered on imaging. In this manuscript, we review selected radiographic manifestations of therapeutic radiation to the head, neck, and spine that may be encountered in the practice of radiology. Methods: We conducted an extensive literature review of known complications of radiation therapy in the head, neck, and spine. We excluded intracranial and pulmonary radiation effects from our search. We selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications. Results: Based on our initial literature search and imaging database review, we selected cases of radiation-induced tumors, radiation tissue necrosis (osteoradionecrosis and soft tissue necrosis), carotid stenosis and blowout secondary to radiation, enlarging thyroglossal duct cysts, radiation myelopathy, and radiation-induced vertebral compression fractures. Conclusions: We describe the clinical and imaging features of selected sequelae of radiation therapy to the head, neck, and spine, with a focus on those with characteristic imaging findings that can be instrumental in helping to make the diagnosis. Knowledge of these entities and their imaging findings is crucial for accurate diagnosis. Not only do radiologists play a key role in early detection of these entities, but many of these entities can be misinterpreted if one is not familiar with them.

Original languageEnglish (US)
Pages (from-to)427-436
Number of pages10
JournalNeuroradiology Journal
Issue number4
StatePublished - Aug 2022


  • Head and neck radiation
  • radiation complications
  • radiation-induced malignancy
  • spine radiation
  • therapeutic radiation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


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