a Department of Oncology , Skåne University Hospital and IKVL, Lund University , Lund , Sweden.
b Department of Diagnostic Radiology , Skåne University Hospital and Clinical Sciences, Lund University , Lund , Sweden.
Acta Oncol. 2019 Jul;58(7):1021-1028. doi: 10.1080/0284186X.2019.1571279. Epub 2019 Feb 12.
Cranial radiotherapy (CRT) is a known risk factor for neurocognitive impairment in survivors of childhood acute lymphoblastic leukemia (ALL). Diffusion tensor imaging (DTI) and diffusional kurtosis imaging (DKI) are MRI techniques that quantify microstructural changes in brain white matter (WM) and DKI is regarded as the more sensitive of them. Our aim was to more thoroughly understand the nature of cognitive deficits after cranial radiotherapy (CRT) in adulthood after childhood ALL. Thirty-eight (21 women) ALL survivors, median age 38 (27-46) years, were investigated at median 34 years after diagnosis. All had been treated with a CRT dose of 24 Gy and with 11 years of complete hormone supplementation. DTI and DKI parameters were determined and neurocognitive tests were performed in ALL survivors and 29 matched controls. ALL survivors scored lower than controls in neurocognitive tests of vocabulary, memory, learning capacity, spatial ability, executive functions, and attention ( < .001). The survivors had altered DTI parameters in the fornix, uncinate fasciculus, and ventral cingulum (all < .05) and altered DKI parameters in the fornix, uncinate fasciculus, and dorsal and ventral cingulum ( < .05). Altered DTI parameters in the fornix were associated with impaired episodic verbal memory ( = -0.40, < .04). The left and right uncinate fasciculus ( = 0.6, < .001), ( = -0.5, < .02) as well as the right ventral cingulum ( = 0.5, < .007) were associated with impaired episodic visual memory. Altered DKI parameters in the fornix, right uncinate fasciculus ( = 0.3, = 0.05, = .02), and ventral cingulum ( = 0.3, = .02) were associated with impaired results of episodic visual memory. ALL survivors with cognitive deficits demonstrated microstructural damage in several WM tracts that were more extensive with DKI as compared to DTI; this might be a marker of radiation and chemotherapy neurotoxicity underlying cognitive dysfunction.
颅放疗（CRT）是儿童急性淋巴细胞白血病（ALL）幸存者发生神经认知障碍的已知危险因素。弥散张量成像（DTI）和弥散峰度成像（DKI）是量化脑白质（WM）微观结构变化的 MRI 技术，DKI 被认为更为敏感。我们的目的是更深入地了解儿童 ALL 后成年期 CRT 后认知缺陷的性质。 38 名（21 名女性）ALL 幸存者，中位年龄 38（27-46）岁，在诊断后中位时间 34 年时进行了研究。所有患者均接受 24Gy 的 CRT 剂量治疗，并接受了 11 年的完整激素补充治疗。在 ALL 幸存者和 29 名匹配的对照者中，我们测定了 DTI 和 DKI 参数，并进行了神经认知测试。 ALL 幸存者在词汇、记忆、学习能力、空间能力、执行功能和注意力等神经认知测试中的得分均低于对照组（ < .001）。幸存者的穹窿、钩束和腹侧扣带束的 DTI 参数发生了改变（均 < .05），穹窿、钩束和背侧及腹侧扣带束的 DKI 参数也发生了改变（均 < .05）。穹窿的 DTI 参数改变与情景性言语记忆受损相关（ = -0.40， < .04）。左侧和右侧钩束（ = 0.6， < .001），（ = -0.5， < .02）以及右侧腹侧扣带束（ = 0.5， < .007）与情景性视觉记忆受损相关。穹窿、右侧钩束（ = 0.3， = 0.05， = 0.02）和腹侧扣带束（ = 0.3， = 0.02）的 DKI 参数改变与情景性视觉记忆的受损结果相关。 存在认知缺陷的 ALL 幸存者在多个 WM 束中表现出微观结构损伤，与 DTI 相比，DKI 检测到的损伤更广泛；这可能是认知功能障碍的辐射和化疗神经毒性的标志物。
