Millar Barbara-Ann M, Purdie Thomas G, Yeung Ivan, Pond Gregory R, Billingsley Susan, Wong Rebecca, Haddad Peiman, Wong C Shun, Laperriere Normand
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
J Neurooncol. 2005 Feb;71(3):281-6. doi: 10.1007/s11060-004-1722-2.
To assess perfusion changes within brain and correlate these with clinical symptoms during whole brain radiotherapy (WBRT) for cerebral metastases.
Fourteen patients with cerebral metastases underwent dynamic CT perfusion scans during palliative whole brain irradiation. Perfusion scans were performed on Day 1 prior to initial radiotherapy treatment, then on Day 2, and on Day 5 immediately after completion of radiotherapy. Measurements of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and capillary surface area permeability product (PS) were performed for each perfusion scan, and daily symptom assessment was taken prior to initial perfusion scan and thereafter prior to each daily radiation treatment.
Utilizing Day 1 as baseline, a 19% increase (P = 0.033) was noted in PS at Day 2, (median 1.47 ml/100 g/min), which returned to Day 1 range at Day 5 (median 1.31 ml/100 g/min). When symptoms were correlated with perfusion parameters, a statistically significant association between change in MTT with change in headache scores was observed, baseline to Day 2 (P = 0.019), and a trend between change in nausea scores with change in CBV (P = 0.059) as well as change in MTT (P = 0.098), baseline to Day 5.
This study has demonstrated the feasibility of a non-invasive technique to assess changes occurring within the human brain during a course of radiation treatment. Dynamic perfusion tomography provides insight into the pathophysiological processes taking place and allows correlation with patient symptomatology.
评估脑转移瘤全脑放疗（WBRT）期间脑内灌注变化，并将这些变化与临床症状相关联。
14例脑转移瘤患者在姑息性全脑照射期间接受了动态CT灌注扫描。在初始放疗前第1天、第2天以及放疗完成后第5天立即进行灌注扫描。对每次灌注扫描进行脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）和毛细血管表面积通透性乘积（PS）的测量，并在初始灌注扫描前以及此后每次放疗前进行每日症状评估。
以第1天为基线，第2天PS增加了19%（P = 0.033）（中位数为1.47 ml/100 g/min），第5天恢复到第1天的范围（中位数为1.31 ml/100 g/min）。当症状与灌注参数相关联时，观察到MTT变化与头痛评分变化之间存在统计学显著关联，从基线到第2天（P = 0.019），以及从基线到第5天恶心评分变化与CBV变化（P = 0.059）以及MTT变化（P = 0.098）之间存在趋势。
本研究证明了一种非侵入性技术在评估放射治疗过程中人类脑内发生的变化方面的可行性。动态灌注断层扫描可深入了解正在发生的病理生理过程，并允许与患者症状学相关联。
