Kłos Justyna, Kloet Reina W, van der Weide Hiska L, Ng Wei Siang Kelvin, Sinnige Peter F, Kramer Miranda C A, Dierckx Rudi A J O, Borra Ronald J H, van der Hoorn Anouk
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen 9713GZ, the Netherlands.
Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen 9713GZ, the Netherlands.
Res Diagn Interv Imaging. 2023 Aug 14;7:100033. doi: 10.1016/j.redii.2023.100033. eCollection 2023 Sep.
Cerebral microbleeds (CMBs) and fluid-attenuated-inversion recovery (FLAIR) hyperintensities on brain MRI scans after radiotherapy (RT) are considered markers for microvascular damage and related cognitive changes. However, the spatial distribution using existing scoring systems as well as colocation of these imaging biomarkers remain unclear, hampering clinical interpretation. This study aims to elucidate the distribution and colocation of these markers in patients with lower grade glioma (LGG).
CMBs were spatially classified on retrospective 1.5 T susceptibility weighted MRI scans according to the existing Microbleed Anatomical Rating Scale (MARS) and were additionally scored for being located in hippocampus, amygdala, cortex, white matter (WM), grey matter (GM), WM/GM junction and for their spatial relation to FLAIR hyperintensities. Scoring was performed for whole, ipsilateral and contralateral cerebrum (with respect to tumour bulk).
Fifty-one scans were included of which 28 had at least one CMB. The majority of CMBs were localized in the lobar area and in deep and periventricular white matter (DPWM) - generally in WM. Only few CMBs were found in GM. In scans obtained up to 7 years after RT completion the majority of CMBs were not colocalized with FLAIR hyperintensities.
CMBs and FLAIR hyperintensities appear to be separate imaging biomarkers for radiation therapy induced microvascular damage, as they are not colocalized in patients with LGG, especially not early on after completion of RT.
放疗（RT）后脑MRI扫描中的脑微出血（CMB）和液体衰减反转恢复（FLAIR）高信号被认为是微血管损伤及相关认知变化的标志物。然而，使用现有评分系统的空间分布以及这些成像生物标志物的共定位仍不清楚，这妨碍了临床解读。本研究旨在阐明这些标志物在低级别胶质瘤（LGG）患者中的分布和共定位情况。
根据现有的微出血解剖评分量表（MARS），对回顾性1.5T磁共振敏感加权成像扫描中的CMB进行空间分类，并额外对位于海马体、杏仁核、皮质、白质（WM）、灰质（GM）、WM/GM交界处的CMB及其与FLAIR高信号的空间关系进行评分。对整个大脑、同侧大脑和对侧大脑（相对于肿瘤体积）进行评分。
纳入51次扫描，其中28次至少有一个CMB。大多数CMB位于脑叶区域以及深部和脑室周围白质（DPWM）——通常在白质中。仅在灰质中发现少数CMB。在放疗完成后长达7年的扫描中，大多数CMB与FLAIR高信号不共定位。
CMB和FLAIR高信号似乎是放疗诱导微血管损伤的独立成像生物标志物，因为它们在LGG患者中不共定位，尤其是在放疗完成后早期。
