Gimber Lana Hirai, Garland Linda, Krupinski Elizabeth A, Chadaz Tyson S, Schwenk Michael, Najafi Bijan, Taljanovic Mihra S
Department of Medical Imaging, The University of Arizona, College of Medicine, Banner-University Medical Center, Tucson, AZ.
University of Arizona Cancer Center, Tucson, AZ.
Curr Probl Diagn Radiol. 2019 Mar-Apr;48(2):121-126. doi: 10.1067/j.cpradiol.2017.12.012. Epub 2018 Jan 6.
Chemotherapy induced peripheral neuropathy (CIPN) is seen in up to 75% of treated cancer patients and can drastically limit their medical management and affect quality of life. Clinical and electrodiagnostic testing for CIPN have many pitfalls. Magnetic resonance neurography (MRN) is being increasingly used in the evaluation of peripheral nerves. Diffusion tensor imaging (DTI) shows promise in the workup of peripheral nerves. In this prospective pilot study, we investigated a possible relationship between DTI and peripheral neuropathy of the ankle and foot in cancer patients treated with chemotherapy.
Nine cancer patients with and without CIPN were clinically evaluated using vibratory perception threshold (VPT) testing. VPT score of >25Volts defined presence of CIPN. The posterior tibial nerve and branches in both feet were imaged using MRN and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured at the posterior tibial, medial plantar, and lateral plantar nerves. Measurements for the CIPN group were compared to without CIPN by VPT cutoff. Correlations and possible relationships between DTI parameters and CIPN were analyzed.
A total of 16feet of 9 enrolled patients were imaged (9feet with CIPN and 7feet without CIPN). Average age was 60.6 ± 13.4 years (range: 33-74). Posterior tibial nerve ADC values were significantly lower than the medial plantar nerve ADC values in all feet (F = 3.50, P = 0.04). We found a correlation with FA and ADC values at specific nerve locations with CIPN, with the left medial plantar nerve FA value and left lateral plantar nerve ADC value demonstrating the strongest positive correlations (0.73 and 0.62, respectively).
The use of DTI for assessing CIPN is challenging but promising. This pilot study provides preliminary data showing correlations between FA and ADC measurements with CIPN and potential utility of DTI as a predictive marker of onset and severity of CIPN in the ankle and foot, which could aid in preventive strategies. Larger, prospective DTI studies are needed to draw definitive conclusions.
MRN with DTI shows promising results as a potential predictive marker of CIPN in the ankle and foot.
化疗引起的周围神经病变（CIPN）在高达75%的接受治疗的癌症患者中出现，可严重限制其治疗并影响生活质量。CIPN的临床和电诊断测试存在许多缺陷。磁共振神经成像（MRN）在周围神经评估中的应用越来越广泛。扩散张量成像（DTI）在周围神经检查中显示出前景。在这项前瞻性初步研究中，我们调查了DTI与接受化疗的癌症患者踝部和足部周围神经病变之间的可能关系。
对9例有或无CIPN的癌症患者进行振动觉阈值（VPT）测试以进行临床评估。VPT评分>25伏定义为存在CIPN。使用MRN和DTI对双足的胫后神经及其分支进行成像。在胫后神经、足底内侧神经和足底外侧神经测量分数各向异性（FA）和表观扩散系数（ADC）值。根据VPT临界值将CIPN组的测量结果与无CIPN组进行比较。分析DTI参数与CIPN之间的相关性和可能的关系。
共对9例入组患者的16只脚进行了成像（9只脚有CIPN，7只脚无CIPN）。平均年龄为60.6±13.4岁（范围：33 - 74岁）。所有足部的胫后神经ADC值均显著低于足底内侧神经ADC值（F = 3.50，P = 0.04）。我们发现特定神经部位的FA和ADC值与CIPN相关，左侧足底内侧神经FA值和左侧足底外侧神经ADC值显示出最强的正相关性（分别为0.73和0.62）。
使用DTI评估CIPN具有挑战性但前景广阔。这项初步研究提供了初步数据，表明FA和ADC测量值与CIPN之间存在相关性，以及DTI作为踝部和足部CIPN发病和严重程度预测标志物的潜在效用，这可能有助于预防策略。需要更大规模的前瞻性DTI研究来得出明确结论。
MRN联合DTI作为踝部和足部CIPN的潜在预测标志物显示出有前景的结果。
