鼻咽癌患者全脑白质内不同的放射性微观结构损伤：一项使用多壳扩散 MRI 的纵向研究。

Disparate Radiation-Induced Microstructural Injuries in Whole-Brain White Matter of Patients With Nasopharyngeal Carcinoma: A Longitudinal Study Using Multishell Diffusion MRI.

机构信息

Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.

School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.

出版信息

J Magn Reson Imaging. 2024 Mar;59(3):976-986. doi: 10.1002/jmri.28674. Epub 2023 Mar 16.

DOI:10.1002/jmri.28674

PMID:36929600

Abstract

BACKGROUND

Evidence for prevention strategies of radiotherapy (RT)-related injury in patients with nasopharyngeal carcinoma (NPC) was lacking. Understanding the dynamic alterations in the cerebral white matter (WM) microstructure after RT may be helpful.

PURPOSE

To investigate the dynamic alterations in the whole brain WM microstructure in patients with NPC in the 12 months after RT using multishell diffusion MRI (MS-dMRI).

STUDY TYPE

Single-center longitudinal study.

POPULATION

A total of 28 treatment-naïve patients with pathologically confirmed NPC (age: 39.68 ± 8.93 years, 11 female) and 20 healthy controls (age: 40.65 ± 9.76 years, 7 female).

FIELD STRENGTH/SEQUENCES: A 3 T, MS-dMRI using a single-shot echo planar imaging sequence.

ASSESSMENT

MS-dMRI was acquired at baseline for the NPC patients and healthy controls, at 0-3 (acute, AC), 6 (early delayed, ED) and 12 months (late delayed, LD) after RT for the NPC patients. The mean and maximum radiation doses to the temporal lobe were acquired. The quality of images was reviewed. MS-dMRI was analyzed using tract-based spatial statistics (TBSS). The presentations of injury were defined by the findings of TBSS.

STATISTICAL TESTS

Chi-square, t tests, repeated ANOVA, and Spearman-rank correlation analysis were used. P < 0.05 was considered to be statistically significant.

RESULTS

TBSS showed two WM injuries (injuries 1 and 2). Injury 1 emerged in the ED phase in the bilateral temporal poles and persisted throughout the ED and LD phases. Injury 2 developed from the AC to ED phase in the bilateral hemisphere and partially recovered in the LD phase. In the ED and LD phases, the multiple diffusion metrics were well correlated (r > 0.5 or <-0.5) with the RT dose, especially in the WM tracts in the temporal lobes.

DATA CONCLUSION

Disparate WM injuries were observed in NPC patients after RT. The injuries may be primarily or secondarily induced by radiation. Injury 1 may be irreversible, while injury 2 seems to partially recover.

EVIDENCE LEVEL

TECHNICAL EFFICACY

Stage 4.

摘要

背景

鼻咽癌（NPC）患者放疗（RT）相关损伤的预防策略证据不足。了解 RT 后大脑白质（WM）微观结构的动态变化可能会有所帮助。

目的

使用多壳扩散 MRI（MS-dMRI）研究 NPC 患者 RT 后 12 个月内全脑 WM 微观结构的动态变化。

研究类型

单中心纵向研究。

人群

共 28 例未经治疗的病理证实的 NPC 患者（年龄：39.68±8.93 岁，11 例女性）和 20 名健康对照者（年龄：40.65±9.76 岁，7 例女性）。

磁场强度/序列：3T，使用单次激发回波平面成像序列的 MS-dMRI。

评估

NPC 患者和健康对照者在基线时进行 MS-dMRI 检查，NPC 患者在 RT 后 0-3 个月（急性期，AC）、6 个月（早期迟发性，ED）和 12 个月（晚期迟发性，LD）时进行检查。获取颞叶的平均和最大辐射剂量。对图像质量进行了回顾性评估。使用基于束的空间统计学（TBSS）分析 MS-dMRI。根据 TBSS 的发现来定义损伤的表现。

统计学检验

采用卡方检验、t 检验、重复方差分析和 Spearman 秩相关分析。P<0.05 被认为具有统计学意义。

结果

TBSS 显示了 2 种 WM 损伤（损伤 1 和 2）。损伤 1 在 ED 期出现在双侧颞极，在 ED 和 LD 期持续存在。损伤 2 在 AC 到 ED 期出现在双侧半球，在 LD 期部分恢复。在 ED 和 LD 期，多个扩散指标与 RT 剂量呈高度相关（r>0.5 或 <-0.5），尤其是在颞叶的 WM 束中。