低级别胶质瘤患者对侧大脑中基于扩散张量成像磁共振成像（DTI-MRI）得出的指标与放疗剂量范围之间的关系
Relationship between DTI-MRI derived metrics and radiotherapy dose range in the contralateral cerebrum in lower grade glioma.
作者信息
Kłos Justyna, Dijkstra Hildebrand, van der Weide Hiska L, Potze Jan H, Sinnige Peter F, Ng Wei Siang Kelvin, Dierckx Rudi A J O, Borra Ronald J H, Kramer Miranda C A, van der Hoorn Anouk
机构信息
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
出版信息
Front Oncol. 2025 Jul 9;15:1406340. doi: 10.3389/fonc.2025.1406340. eCollection 2025.
BACKGROUND AND PURPOSE
To evaluate the value of diffusion tensor imaging (DTI) MRI derived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) for both white matter (WM) and grey matter (GM) of the contralateral cerebrum following radiotherapy (RT) for supratentorial lower grade glioma (LGG) as markers for radiotherapy-induced brain damage (RIBD).
MATERIALS AND METHODS
14 patients were analysed. WM and GM were segmented using automated software (cNeuro) and the mean FA and ADC were extracted per RT dose bin (0-10, 10-20, 20-30, 30-40, 40-50, >50 Gy) of WM and GM. One way ANOVA with Bonferroni's test were used to analyse differences in FA and ADC between dose bins. Fluid-attenuated inversion recovery (FLAIR) hyperintensities were segmented in a semi-automated manner and correlated with a percentual difference in ADC and FA between dose bin ≥50 Gy and the mean of lower dose bins. Furthermore, the correlation of raw values of these 3 metrics within dose bins was explored, and potential relations of changes to clinical parameters.
RESULTS
We observed changes in FA of WM for dose bin >50 Gy [(F(5, 74) = 5.461, p=0.0002)], but no changes in FA of GM and no changes in ADC for both WM and GM. The percentual change in ADC and FA in WM of dose bin >50 Gy did not correlate with the total volume of FLAIR hyperintensities of the contralateral cerebrum, and also the raw values of these metrics did not correlate within the >50 Gy dose bin, and only correlated with the Total Radiotherapy Dose delivered to the supratentorial brain.
CONCLUSION
In the late phase after RT for LGG (average > 3 years), DTI-MRI derived FA values decreased significantly in WM in the cerebrum contralateral to the tumour, while no changes were observed in GM or in ADC values. The FA decrease is only observed in areas receiving the highest RT dose, allows for a localized assessment in the individual patient, and is not correlated with the observed total load of FLAIR hyperintensities within the contralateral cerebrum or changes in ADC, suggesting DTI-MRI and FLAIR derived metrics reflect RIBD in different ways.
背景与目的
评估扩散张量成像（DTI）磁共振成像（MRI）得出的分数各向异性（FA）和表观扩散系数（ADC）在幕上低级别胶质瘤（LGG）放疗（RT）后对侧大脑白质（WM）和灰质（GM）的价值，作为放疗诱发脑损伤（RIBD）的标志物。
材料与方法
分析了14例患者。使用自动化软件（cNeuro）对白质和灰质进行分割，并按白质和灰质的每个放疗剂量区间（0 - 10、10 - 20、20 - 30、30 - 40、40 - 50、>50 Gy）提取平均FA和ADC。采用单因素方差分析及Bonferroni检验分析各剂量区间之间FA和ADC的差异。以半自动方式分割液体衰减反转恢复（FLAIR）高信号，并将其与≥50 Gy剂量区间和较低剂量区间平均值之间的ADC和FA百分比差异相关联。此外，还探讨了这3个指标在剂量区间内原始值的相关性以及变化与临床参数的潜在关系。
结果
我们观察到剂量区间>50 Gy时白质的FA有变化[（F(5, 74) = 5.461，p = 0.0002）]，但灰质的FA无变化，白质和灰质的ADC均无变化。剂量区间>50 Gy时白质中ADC和FA的百分比变化与对侧大脑FLAIR高信号的总体积无关，并且这些指标的原始值在>50 Gy剂量区间内也不相关，仅与幕上脑接受的总放疗剂量相关。
结论
在LGG放疗后的晚期阶段（平均>3年），DTI - MRI得出的FA值在肿瘤对侧大脑的白质中显著降低，而灰质或ADC值未观察到变化。FA降低仅在接受最高放疗剂量的区域观察到，可对个体患者进行局部评估，且与对侧大脑中观察到的FLAIR高信号的总负荷或ADC变化无关，表明DTI - MRI和FLAIR得出的指标以不同方式反映RIBD。
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