一位62岁，吸烟40年，患有严重慢性阻塞性肺疾病及右上肺非小细胞肺癌早期的女性接受了立体定向放射治疗（SABR）。治疗两年后，一次监测计算机断层扫描显示后4和5肋骨的病变，包括异常的髓扩张，提示可能的恶性浸润。随后的磁共振成像（MRI）扫描显示这些病变是放射治疗后愈合的骨折。虽然通常耐受，但已知SABR会在目标区域和风险器官产生炎症和纤维化改变，而肋骨骨折是一个已经确立的不良事件。MRI具有较高的诊断准确性和敏感性，能够排除恶性扩散。这个案例表明了对早期非小细胞肺癌SABR治疗后进行定期随访的必要性，以及解释不确定的SABR后放射学发现的挑战。©2023作者。S. Karger AG, Basel出版。

A 62-year-old woman with a 40-pack-year smoking history and severe chronic obstructive pulmonary disease with early-stage right upper lobe non-small cell lung cancer (NSCLC) was treated with stereotactic ablative radiotherapy (SABR). Two years after treatment, a surveillance computerized tomography scan showed lesions of the posterior 4th and 5th ribs including expansion of the medulla that was unusual and of concern for possible malignant infiltration. A follow-up magnetic resonance imaging (MRI) scan revealed these lesions to be healing fractures post-radiotherapy. Although generally well tolerated, SABR is known to produce inflammatory and fibrotic changes both in-field and in organs at risk, and rib fractures are a well-established adverse event. MRI has high diagnostic accuracy and sensitivity for rib fractures and was able to rule out malignant spread. This case demonstrates the need for regular follow-up following SABR for early-stage NSCLC, as well as the challenge of interpreting indeterminate post-SABR radiography findings.© 2023 The Author(s). Published by S. Karger AG, Basel.