评估接受立体定向放射外科治疗的脑转移瘤患者的生理磁共振成像参数——初步分析与病例报告
Evaluating Physiological MRI Parameters in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery-A Preliminary Analysis and Case Report.
作者信息
van Grinsven Eva E, de Leeuw Jordi, Siero Jeroen C W, Verhoeff Joost J C, van Zandvoort Martine J E, Cho Junghun, Philippens Marielle E P, Bhogal Alex A
机构信息
Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX Utrecht, The Netherlands.
Department of Radiology, Center for Image Sciences, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
出版信息
Cancers (Basel). 2023 Aug 28;15(17):4298. doi: 10.3390/cancers15174298.
Brain metastases occur in ten to thirty percent of the adult cancer population. Treatment consists of different (palliative) options, including stereotactic radiosurgery (SRS). Sensitive MRI biomarkers are needed to better understand radiotherapy-related effects on cerebral physiology and the subsequent effects on neurocognitive functioning. In the current study, we used physiological imaging techniques to assess cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO) and cerebrovascular reactivity (CVR) before and three months after SRS in nine patients with brain metastases. The results showed improvement in OEF, CBF and CMRO within brain tissue that recovered from edema (all ≤ 0.04), while CVR remained impacted. We observed a global post-radiotherapy increase in CBF in healthy-appearing brain tissue ( = 0.02). A repeated measures correlation analysis showed larger reductions within regions exposed to higher radiotherapy doses in CBF ( = -0.286, < 0.001), CMRO ( = -0.254, < 0.001), and CVR ( = -0.346, < 0.001), but not in OEF ( = -0.004, = 0.954). Case analyses illustrated the impact of brain metastases progression on the post-radiotherapy changes in both physiological MRI measures and cognitive performance. Our preliminary findings suggest no radiotherapy effects on physiological parameters occurred in healthy-appearing brain tissue within 3-months post-radiotherapy. Nevertheless, as radiotherapy can have late side effects, larger patient samples allowing meaningful grouping of patients and longer follow-ups are needed.
脑转移瘤发生于10%至30%的成年癌症患者中。治疗包括不同的(姑息性)选择,其中包括立体定向放射外科治疗(SRS)。需要敏感的MRI生物标志物来更好地了解放疗对脑生理学的相关影响以及随后对神经认知功能的影响。在本研究中,我们使用生理成像技术评估了9例脑转移瘤患者在SRS治疗前及治疗后3个月的脑血流量(CBF)、氧摄取分数(OEF)、脑氧代谢率(CMRO)和脑血管反应性(CVR)。结果显示,从水肿中恢复的脑组织内OEF、CBF和CMRO有所改善(均≤0.04),而CVR仍受影响。我们观察到放疗后外观正常的脑组织中CBF整体增加(=0.02)。重复测量相关分析显示,在接受较高放疗剂量的区域内,CBF(=-0.286,<0.001)、CMRO(=-0.254,<0.001)和CVR(=-0.346,<0.001)的降低幅度更大,但OEF没有(=-0.004,=0.954)。病例分析说明了脑转移瘤进展对放疗后生理MRI测量值和认知表现变化的影响。我们的初步研究结果表明,放疗后3个月内,外观正常的脑组织对生理参数没有放疗效应。然而,由于放疗可能有晚期副作用,因此需要更大的患者样本以进行有意义的患者分组并进行更长时间的随访。
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