Early Detection of Radiation-Induced Injury and Prediction of Cognitive Deficit by MRS Metabolites in Radiotherapy of Low-Grade Glioma

Abstract

Purpose. To compare the sensitivity of MRS metabolites and MoCA and ACE-R cognitive tests in the detection of radiation-induced injury in low grade glioma (LGG) patients in early and early delayed postradiation stages. Methods. MRS metabolite ratios of NAA/Cr and Cho/Cr, ACE-R and MoCA cognitive tests, and dosimetric parameters in corpus callosum were analyzed during RT and up to 6-month post-RT for ten LGG patients. Results. Compared to pre RT baseline, a significant decline in both NAA/Cr and Cho/Cr in the corpus callosum was seen at the 4th week of RT, 1, 3, and 6-month post-RT. These declines were detected at least 3 months before the detection of declines in cognitive functions by ACE-R and MoCA tools. Moreover, NAA/Cr alterations at 4th week of RT and 1-month post-RT were significantly negatively correlated with the mean dose received by the corpus callosum, as well as the corpus callosum 40 Gy dose volume, i.e., the volume of the corpus callosum receiving a dose greater than 40 Gy. Conclusion. MRS-based biomarkers may be more sensitive than the state-of-the-art cognitive tests in the prediction of postradiation cognitive impairments. They would be utilized in treatment planning and dose sparing protocols, with a specific focus on the corpus callosum in the radiation therapy of LGG patients.

A systematic review on the use of quantitative imaging to detect cancer therapy adverse effects in normal-appearing brain tissue

“…Hippocampal metabolic changes were reported 1 month [ 76 ] and 4 months after WBRTx [ 77 , 78 ]. Additionally, a progressive worsening was reported between week 4 of 3D-CRTx until 6 months after, with NAA/Cr in the corpus callosum further decreased from 10 to up to 18% [ 79 ]. However, the decrease of NAA/Cho by 19% 4 months after RTx resolved to pre-therapeutic levels another 4 months later in another study [ 80 ].…”

“…The metabolic changes reported in brain-RTx patients correlated with a decrease in cognitive performance in most studies. NAA/Cr in corpus callosum after 1 month correlated positively with verbal fluency score and visuospatial functioning at 6 months, while Cho/Cr correlated negatively with the memory functioning score [ 79 ]. Hippocampal NAA/Cr correlated positively with the visuospatial memory test scores ( r = 0.66; p = 0.008) [ 78 ].…”

“…However, the correlation with imaging biomarkers was not always corrected for multiple comparisons, possibly invalidating the positive findings. Only nine studies have either described that a proper correction for multiple comparisons was used [ 44 , 51 , 79 , 90 , 117 ] or examined a correlation with a single test only [ 69 , 91 , 116 , 126 ].…”

Classification of Benign and Malignant Features of Glioma and Prediction of Early Metastasis and Recurrence Based on Enhanced MRI Imaging

“…Recent studies have proved that magnetic resonance imaging is of great value in the metabolic and physiological processes of gliomas, such as DWI [20]. DTI [21], MRS [22,23], DSC MRI [24,25], and DCE MRI have achieved good results in the evaluation of glioma grading [26,27]. In addition, the evaluation of tumor heterogeneity through imaging is of great benefit to guide the clinic, especially in the individualized treatment of gliomas.…”

Multi-parametric magnetic resonance imaging assessment of response to chemo-radiotherapy in tumors of glioma cell types: a prospective study

“…In other words, tumor recurrence and CRT -induced necrosis cannot be distinguished for a complete diagnosis, and the need for advanced MRI techniques seems essential (Travers et al 2021;Feng et al 2022;Perez-Torres et al 2014). Quantitative MRI methods such as diffusionweighted imaging (DWI), and magnetic spectroscopy sequence imaging (MRSI), have played a very important role in the initial diagnosis and follow-up of the patients in relation to possible recurrence (Seow et al 2018;Abdalla et al 2020;Fink et al 2016;Aslan et al 2018;Alirezaei et al 2021;Hu et al 2021). In addition to the inconsistency in the results of recent studies on changes in quantitative MRI biomarkers after treatment (Neumann et al 2020;Gerstner et al 2018;Wirsching et al 2016;Tabatabai et al 2011;Hide et al 2009;Smits.…”