Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA.
Department of Radiation Oncology, George Washington University, Washington DC, USA.
Neuro Oncol. 2021 Aug 2;23(8):1393-1403. doi: 10.1093/neuonc/noab017.
We explored fine motor skills (FMS) before and after brain radiotherapy (RT), analyzing associations between longitudinal FMS and imaging biomarkers of cortical and white matter (WM) integrity in motor regions of interest (ROIs).
On a prospective trial, 52 primary brain tumor patients receiving fractionated brain RT underwent volumetric brain MRI, diffusion tensor imaging, and FMS assessments (Delis-Kaplan Executive Function System Trail Making Test Motor Speed [DKEFS-MS], Grooved Pegboard Dominant Hands [PDH], and Grooved Pegboard Nondominant Hands [PNDH]) at baseline and 3-, 6-, and 12-month post-RT. Motor ROIs autosegmented included: sensorimotor cortices and superficial WM, corticospinal tracts, cerebellar cortices and WM, and basal ganglia. Volume (cc) was measured in all ROIs at each timepoint. Diffusion biomarkers (FA [fractional anisotropy] and MD [mean diffusivity]) were additionally measured in WM ROIs. Linear mixed-effects models assessed biomarkers as predictors of FMS scores. P values were corrected for multiple comparisons.
Higher RT dose was associated with right paracentral cortical thinning (β = -2.42 Gy/(month × mm), P = .03) and higher right precentral WM MD (β = 0.69 Gy/(month × µm2/ms), P = .04). Higher left (β = 38.7 points/(month × µm2/ms), P = .004) and right (β = 42.4 points/(month × µm2/ms), P = .01) cerebellar WM MD, left precentral cortical atrophy (β = -8.67 points/(month × mm), P = .02), and reduced right cerebral peduncle FA (β = -0.50 points/month, P = .01) were associated with worse DKEFS-MS performance. Left precentral cortex thinning was associated with worse PDH scores (β = -17.3 points/(month × mm), P = .02). Left (β = -0.87 points/(month × cm3), P = .001) and right (β = -0.64 points/(month × cm3), P = .02) cerebellar cortex, left pons (β = -19.8 points/(month × cm3), P = .02), and right pallidum (β = -10.8 points/(month × cm3), P = .02) atrophy and reduced right internal capsule FA (β = -1.02 points/month, P = .03) were associated with worse PNDH performance.
Biomarkers of microstructural injury in motor-associated brain regions were associated with worse FMS. Dose avoidance in these areas may preserve FMS.
我们探讨了脑部放射治疗（RT）前后的精细运动技能（FMS），分析了运动感兴趣区（ROI）皮质和白质（WM）完整性的纵向 FMS 与影像学生物标志物之间的相关性。
在一项前瞻性试验中，52 名原发性脑肿瘤患者接受了分次脑部 RT，他们在基线和 RT 后 3、6 和 12 个月接受了容积脑 MRI、弥散张量成像和 FMS 评估（Delis-Kaplan 执行功能系统追踪测试运动速度[DKEFS-MS]、Grooved Pegboard 优势手[PDH]和 Grooved Pegboard 非优势手[PNDH]）。自动分割的运动 ROI 包括：感觉运动皮质和浅表 WM、皮质脊髓束、小脑皮质和 WM 以及基底节。在每个时间点测量所有 ROI 的体积（cc）。在 WM ROI 中还测量了弥散生物标志物（FA[分数各向异性]和 MD[平均弥散系数]）。线性混合效应模型将生物标志物作为 FMS 评分的预测因子进行评估。对多重比较进行了 P 值校正。
较高的 RT 剂量与右侧旁中央皮质变薄（β=-2.42 Gy/（月×mm），P=0.03）和右侧中央前 WM MD 升高（β=0.69 Gy/（月×µm2/ms），P=0.04）相关。较高的左侧（β=38.7 分/（月×µm2/ms），P=0.004）和右侧（β=42.4 分/（月×µm2/ms），P=0.01）小脑 WM MD、左侧中央前皮质萎缩（β=-8.67 分/（月×mm），P=0.02）和右侧大脑脚 FA 降低（β=-0.50 分/月，P=0.01）与 DKEFS-MS 表现恶化相关。左侧中央前皮质变薄与 PDH 评分下降相关（β=-17.3 分/（月×mm），P=0.02）。左侧（β=-0.87 分/（月×cm3），P=0.001）和右侧（β=-0.64 分/（月×cm3），P=0.02）小脑皮质、左侧脑桥（β=-19.8 分/（月×cm3），P=0.02）和右侧苍白球（β=-10.8 分/（月×cm3），P=0.02）萎缩和右侧内囊 FA 降低（β=-1.02 分/月，P=0.03）与 PNDH 表现恶化相关。
运动相关脑区的微观结构损伤生物标志物与 FMS 恶化相关。这些区域的剂量回避可能有助于保护 FMS。
