Yang Fangxue, Wang Dongcui, Su Yihang, Tang Jingyi, Zhang Youming, He Jiaqi, Liu Shulin, Li Sai, An Yongcheng, Zhao Qing, Liao Weihua
Department of Radiology, Xiangya Hospital of Central South University, Changsha 410008, China.
Department of Radiology, Xiangya Hospital of Central South University, Changsha 410008, China.
Radiother Oncol. 2025 Sep;210:111012. doi: 10.1016/j.radonc.2025.111012. Epub 2025 Jul 1.
The aim of this study was to investigate the dynamic changes of glymphatic function during the different pre-symptomatic phases of Radiation-induced Brain Injury (RBI).
In this cross-sectional study, a total of 108 NPC patients (85 in the post-RT and 23 in the pre-RT group) and 33 healthy controls (HCs) were included. The post-RT group was further divided into three subgroups based on the time interval between RT and MRI scanning: 36 patients in post-RT, 25 patients in post-RT, and 24 patients in post-RT. Glymphatic function was assessed using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. DTI-ALPS , DTI-ALPS , and DTI-ALPS index were calculated for all NPC patients; DTI-ALPS index was calculated for HCs. Differences in the DTI-ALPS index among groups were evaluated using one-way analysis of variance with Bonferroni post hoc tests. Pearson correlation analysis was conducted to investigate the relationship between radiotherapy dose and the DTI-ALPS index.
We observed a tendency of reduced DTI-ALPS , DTI-ALPS , and DTI-ALPS index in post-RT groups compared to pre-RT group and HCs (p < 0.05). Specifically, the DTI-ALPS index exhibited dynamic change patterns at different post-RT stages (p < 0.001): pre-RT (1.875 ± 0.323), post-RT (1.646 ± 0.213), post-RT (1.823 ± 0.307), and post-RT (1.720 ± 0.250) groups. This trend was consistent for both DTI-ALPS index (p = 0.003) and DTI-ALPS index (p = 0.016).
These findings demonstrated that the glymphatic system underwent a dynamic process of damage, repair, and eventual homeostasis disruption at different pre-symptomatic stages of RBI. Future longitudinal studies could further elucidate the temporal dynamics of these changes.
本研究旨在探讨放射性脑损伤（RBI）不同症状前期阶段脑淋巴系统功能的动态变化。
在这项横断面研究中，共纳入108例鼻咽癌患者（放疗后组85例，放疗前组23例）和33例健康对照者（HCs）。放疗后组根据放疗与MRI扫描的时间间隔进一步分为三个亚组：放疗后1组36例患者，放疗后2组25例患者，放疗后3组24例患者。采用沿血管周围间隙的扩散张量成像（DTI-ALPS）指数评估脑淋巴系统功能。计算所有鼻咽癌患者的DTI-ALPS1、DTI-ALPS2和DTI-ALPS3指数；计算健康对照者的DTI-ALPS1指数。采用单因素方差分析及Bonferroni事后检验评估各组间DTI-ALPS指数的差异。进行Pearson相关分析以研究放疗剂量与DTI-ALPS指数之间的关系。
我们观察到，与放疗前组和健康对照者相比，放疗后组的DTI-ALPS1、DTI-ALPS2和DTI-ALPS3指数有降低趋势（p<0.05）。具体而言，DTI-ALPS1指数在放疗后的不同阶段呈现动态变化模式（p<0.001）：放疗前组（1.875±0.323）、放疗后1组（1.646±0.213）、放疗后2组（1.823±0.307）和放疗后3组（1.720±0.250）。DTI-ALPS2指数（p=0.003）和DTI-ALPS3指数（p=0.016）也呈现出一致的趋势。
这些发现表明，在RBI的不同症状前期阶段，脑淋巴系统经历了损伤、修复以及最终内环境稳态破坏的动态过程。未来纵向研究可能会进一步阐明这些变化的时间动态过程。
