Huang Lin-Wen, Pan Jia-Wei, Li Bo, Wu Wen-Xiu, Guo Li, Zhou Xin-Han, Zhang Xianhai, Gao Ming-Yong, Xu Zhi-Feng
Department of Radiology, The First People's Hospital of Foshan, No. 81 North Lingnan Avenue, Foshan, Guangdong, China.
Department of Information System, The First People's Hospital of Foshan, No. 81 North Lingnan Avenue, Foshan, Guangdong, China.
Radiother Oncol. 2025 Jan;202:110621. doi: 10.1016/j.radonc.2024.110621. Epub 2024 Nov 12.
Three dimensional pulsed continuous arterial spin labeling (3D-pCASL) and incoherent movement within voxels (IVIM) imaging was combined to assess dynamic microscopic structure changes of the hippocampus and temporal lobe white matter (TLWM) of nasopharyngeal carcinoma (NPC) patients post intensity-modulated radiation therapy (IMRT).
Forty-six patients who were first diagnosed with NPC and underwent IMRT were prospectively enrolled. 3D-CASL and IVIM were performed pre-RT, within 1 week (1 W) post-RT, 3 months (3 M) post-RT, 6 months (6 M) post-RT, and 18 months (18 M) post-RT. Twenty-seven patients completed follow-ups for all time periods, and their data were analyzed. The cerebral flow (CBF) derived from ASL, and apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (F) derived from IVIM of hippocampus and TLWM were analyzed. The quantitative parameters were measured before RT as the baseline, and the corresponding parameter values and change rates at each time point post-RT were compared using the non-parametric Wilcoxon rank sum test.
At 1 W post-RT, CBF showed a significant increase and peaked in both the hippocampus and TLWM (p < 0.05) with change rate of 30.3 % and 24.1 %. In the hippocampus, both D and D* were significantly increased from pre-RT to 6 M post-RT with change rate of 6.66 % and 34.7 %, while D*-values remained significantly higher than pre-RT at 12 months post-RT with change rate of 41.2 %. In the TLWM, the F firstly increased and then decreased, and was significantly decreased from pre-RT to 6 M post-RT with change rate of 20.2 %.
3D-PCASL and IVIM can indirectly reflecting the developmental pattern and molecular mechanism of RT induced brain injury.
将三维脉冲连续动脉自旋标记（3D-pCASL）与体素内非相干运动（IVIM）成像相结合，以评估鼻咽癌（NPC）患者调强放射治疗（IMRT）后海马体和颞叶白质（TLWM）的动态微观结构变化。
前瞻性纳入46例初诊为NPC并接受IMRT的患者。在放疗前、放疗后1周（1W）、放疗后3个月（3M）、放疗后6个月（6M）和放疗后18个月（18M）进行3D-CASL和IVIM检查。27例患者完成了所有时间段的随访，并对其数据进行分析。分析了源自动脉自旋标记的脑血流量（CBF），以及源自海马体和TLWM的IVIM的表观扩散系数（ADC）、纯扩散系数（D）、伪扩散系数（D*）和灌注分数（F）。以放疗前的定量参数作为基线，使用非参数Wilcoxon秩和检验比较放疗后各时间点的相应参数值和变化率。
放疗后1周，海马体和TLWM的CBF均显著增加并达到峰值（p<0.05），变化率分别为30.3%和24.1%。在海马体中，从放疗前到放疗后6个月，D和D均显著增加，变化率分别为6.66%和34.7%，而在放疗后12个月，D值仍显著高于放疗前，变化率为41.2%。在TLWM中，F先升高后降低，从放疗前到放疗后6个月显著降低，变化率为20.2%。
3D-PCASL和IVIM可间接反映放疗诱导脑损伤的发展模式和分子机制。
