Voon Noor Shatirah, Manan Hanani Abdul, Yahya Noorazrul
Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia.
Functional Image Processing Laboratory, Department of Radiology, University Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia.
Strahlenther Onkol. 2022 May;198(5):409-426. doi: 10.1007/s00066-022-01905-6. Epub 2022 Mar 3.
Diffusion tensor imaging (DTI) can detect subtle manifestations of white matter (WM) injury following paediatric radiotherapy, which may be a potential biomarker for cognitive changes. This study aimed to synthesise the relationships between DTI indices and cognitive changes following paediatric radiotherapy through systematic review and meta-analysis. PubMed and Scopus electronic databases were used to identify eligible studies. Quality assessment was performed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information on demographics, DTI changes, and associations to cognitive outcomes were extracted. Meta-analyses were performed on DTI changes in specific anatomical locations. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the preparation of this report. Eighteen studies were included (median study size: 21; range 18-146). 17/18 studies showed significant cognitive decline following irradiation. Meta-analyses found significant cognitive changes within patient's group of acute lymphoblastic leukaemia (ALL; standard mean differences [SMD] = -0.075, P = 0.01) and brain tumours (BT; SMD = -1.037, P ≤ 0.001) compared to control/baseline. Both groups also had significantly lower fractional anisotropy (FA) scores in the corpus callosum (ALL: SMD = -0.979, P = 0.002; BT: SMD = -1.025, P < 0.001). Decreased FA was consistently associated with cognitive decline. Correlation on WMFA integrity to cognitive domains was statistically significant (Z = 9.86, P < 0.001) with a large effect size (r = 0.52). White matter tract integrity of the corpus callosum measured with FA has the potential to be a biomarker for radiotherapy-related cognitive decline. Inclusion of DTI in follow-up imaging should be encouraged.
弥散张量成像（DTI）能够检测小儿放疗后白质（WM）损伤的细微表现，这可能是认知变化的一个潜在生物标志物。本研究旨在通过系统评价和荟萃分析，综合小儿放疗后DTI指标与认知变化之间的关系。使用PubMed和Scopus电子数据库来识别符合条件的研究。采用美国国立卫生研究院（NIH）观察性队列和横断面研究质量评估工具进行质量评估。提取有关人口统计学、DTI变化以及与认知结果关联的信息。对特定解剖部位的DTI变化进行荟萃分析。本报告的撰写遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。纳入了18项研究（研究规模中位数：21；范围18 - 146）。17/18项研究显示放疗后存在显著的认知衰退。荟萃分析发现，与对照组/基线相比，急性淋巴细胞白血病（ALL）患者组（标准化均数差[SMD] = -0.075，P = 0.01）和脑肿瘤（BT）患者组（SMD = -1.037，P≤0.001）存在显著的认知变化。两组胼胝体的分数各向异性（FA）得分也均显著降低（ALL：SMD = -0.979，P = 0.002；BT：SMD = -1.025，P < 0.001）。FA降低始终与认知衰退相关。白质FA完整性与认知领域的相关性具有统计学意义（Z = 9.86，P < 0.001），效应量较大（r = 0.52）。用FA测量的胼胝体白质束完整性有可能成为放疗相关认知衰退的生物标志物。应鼓励在随访成像中纳入DTI。
