Khong Pek-Lan, Leung Lucullus H T, Fung Amy S M, Fong Daniel Y T, Qiu Deqiang, Kwong Dora L W, Ooi Gaik-Cheng, McAlonan Grainne, Cao Guang, Chan Godfrey C F
Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
J Clin Oncol. 2006 Feb 20;24(6):884-90. doi: 10.1200/JCO.2005.02.4505.
We aim to determine if the loss of white matter fractional anisotropy (FA), measured by diffusion tensor magnetic resonance imaging (DTI), in post-treatment childhood medulloblastoma (MED) and acute lymphoblastic leukemia (ALL) survivors correlate with intelligence quotient (IQ) scores.
MED and ALL survivors (n = 30; 20 male, 10 female; age range, 6.0 to 22.1 years; mean, 13.1 years) were recruited for DTI and IQ tests. In this cross-sectional study, age-matched normal control (n = 55; 32 male, 23 female; age range, 6.0 to 23 years; mean, 12.1 years) DTI was obtained to compute percentage difference in white matter FA (DeltaFA%) for each patient compared with the age-matched control group. Multivariate regression analysis was performed to determine the relationships between DeltaFA%, age at treatment, irradiation dose, time interval from treatment, and full-scale IQ (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ). Receiver operating characteristics curves were used to determine the best DeltaFA% cutoffs for predicting FSIQ, VIQ, and PIQ of less than 85.
DeltaFA% had a significant effect on FSIQ (adjusted r2 = 0.439; P < .001), VIQ (adjusted r(2) = 0.237; P = .028), and PIQ (adjusted r(2) = 0.491; P < .001) after adjusting for the effects of age at treatment, irradiation dose, and time interval from treatment. The best DeltaFA% value to predict less than 85 scores in FSIQ, VIQ, and PIQ was -3.3% with specificities of 100% and sensitivities ranging from 77.8% to 87.5%.
Our preliminary findings suggest that white matter FA may be a clinically useful biomarker for the assessment of treatment-related neurotoxicity in post-treatment childhood cancer survivors.
我们旨在确定通过扩散张量磁共振成像（DTI）测量的治疗后儿童髓母细胞瘤（MED）和急性淋巴细胞白血病（ALL）幸存者的白质分数各向异性（FA）损失是否与智商（IQ）分数相关。
招募MED和ALL幸存者（n = 30；20名男性，10名女性；年龄范围6.0至22.1岁；平均13.1岁）进行DTI和IQ测试。在这项横断面研究中，获取年龄匹配的正常对照（n = 55；32名男性，23名女性；年龄范围6.0至23岁；平均12.1岁）的DTI，以计算每位患者与年龄匹配对照组相比白质FA的百分比差异（DeltaFA%）。进行多变量回归分析以确定DeltaFA%、治疗时年龄、照射剂量、治疗后时间间隔与全量表智商（FSIQ）、言语智商（VIQ）和操作智商（PIQ）之间的关系。使用受试者操作特征曲线确定预测FSIQ、VIQ和PIQ低于85的最佳DeltaFA%临界值。
在调整治疗时年龄、照射剂量和治疗后时间间隔的影响后，DeltaFA%对FSIQ（调整后r2 = 0.439；P <.001）、VIQ（调整后r(2) = 0.237；P =.028）和PIQ（调整后r(2) = 0.491；P <.001）有显著影响。预测FSIQ、VIQ和PIQ低于85分的最佳DeltaFA%值为-3.3%，特异性为100%，敏感性范围为77.8%至87.5%。
我们的初步研究结果表明，白质FA可能是评估治疗后儿童癌症幸存者治疗相关神经毒性的一种临床有用生物标志物。
