Hu Lanyue, Ding Shaohua, Yao Jun, Zhang Yujie, You Jia, Chen Huiyou, Li Qian, Chen Yu-Chen, Yin Xindao
Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Radiology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, China.
Quant Imaging Med Surg. 2025 Sep 1;15(9):7820-7832. doi: 10.21037/qims-24-1321. Epub 2025 Aug 15.
Chemotherapy-related cognitive impairments (CRCIs) are frequently reported by patients with non-small cell lung cancer (NSCLC) following chemotherapy treatment. Studies have revealed that cognitive impairment may be linked to abnormal spontaneous neuronal activity and changes in cerebral blood flow (CBF). However, the specific impact of neurovascular coupling (NVC) alterations on patients who have undergone chemotherapy has not been clarified. The aim of this study was to examine the variations in NVC in patients with lung cancer postchemotherapy and to determine potential correlations between these NVC alterations and neurocognitive dysfunction.
A sample of 43 patients with NSCLC was recruited, including 20 patients treated with chemotherapy [CT(+)] and 23 chemotherapy-naïve [CT(-)] individuals who underwent pseudocontinuous arterial spin labeling (pCASL) scans and resting-state functional magnetic resonance imaging (rs-fMRI), along with neurocognitive evaluations. Global and regional NVC indices were assessed according to correlation coefficients and the ratios between CBF and neuronal activity-derived metrics, including the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo). Statistical analyses were conducted to calculate the difference between groups and characterize relationships between alterations in global and regional NVC and cognitive performance.
In comparison to the CT(-) group, the CT(+) group exhibited significantly lower coupling strength for global CBF-ALFF and CBF-ReHo correlations (P<0.05). Regionally, the CT(+) group demonstrated a decreased CBF:ALFF ratio in the right middle temporal gyrus (MTG) and left middle frontal gyrus (MFG), as well as an increased CBF:ALFF ratio in the left thalamus and left parahippocampal region. Furthermore, the CT(+) group had higher CBF:ReHo ratios in the left precuneus, right central operculum, right inferior parietal lobule, and right superior occipital gyrus but lower CBF:ReHo ratios in the left inferior frontal gyrus and right MFG (false-discovery rate-corrected P value <0.05). Notably, there was a negative correlation observed between Montreal Cognitive Assessment scores and memory scores and the CBF:ALFF ratios in the right MFG and left parahippocampal region.
This research offers comprehensive insights into the neurological foundations of CRCI. The application of multimodal neuroimaging analyses combining rs-fMRI and pCASL may uncover the induction of neurovascular decoupling in lung cancer patients undergoing chemotherapy.
非小细胞肺癌（NSCLC）患者在化疗后经常报告化疗相关认知障碍（CRCI）。研究表明，认知障碍可能与异常的自发神经元活动和脑血流量（CBF）变化有关。然而，神经血管耦合（NVC）改变对接受化疗患者的具体影响尚未阐明。本研究的目的是检查肺癌化疗后患者的NVC变化，并确定这些NVC改变与神经认知功能障碍之间的潜在相关性。
招募了43例NSCLC患者，包括20例接受化疗的患者[CT(+)]和23例未接受化疗的患者[CT(-)]，他们接受了伪连续动脉自旋标记（pCASL）扫描和静息态功能磁共振成像（rs-fMRI），以及神经认知评估。根据相关系数以及CBF与神经元活动衍生指标之间的比率评估全局和区域NVC指数，这些指标包括低频波动幅度（ALFF）和区域一致性（ReHo）。进行统计分析以计算组间差异，并描述全局和区域NVC改变与认知表现之间的关系。
与CT(-)组相比，CT(+)组在全局CBF-ALFF和CBF-ReHo相关性方面表现出显著更低的耦合强度（P<0.05）。在区域上，CT(+)组在右侧颞中回（MTG）和左侧额中回（MFG）的CBF:ALFF比率降低，而在左侧丘脑和左侧海马旁区域的CBF:ALFF比率增加。此外，CT(+)组在左侧楔前叶、右侧中央 operculum、右侧顶下小叶和右侧枕上回的CBF:ReHo比率较高，但在左侧额下回和右侧MFG的CBF:ReHo比率较低（错误发现率校正P值<0.05）。值得注意的是，蒙特利尔认知评估得分和记忆得分与右侧MFG和左侧海马旁区域的CBF:ALFF比率之间存在负相关。
本研究为CRCI的神经学基础提供了全面的见解。结合rs-fMRI和pCASL的多模态神经影像学分析的应用可能揭示接受化疗的肺癌患者中神经血管解耦的诱导情况。
