Whole-brain changes in white matter microstructure after radiotherapy for nasopharyngeal carcinoma: a diffusion tensor imaging study

Duan, Fuhong; Cheng, Jingliang; Jiang, Jinju; Chang, Jun; Zhang, Yong; Qiu, Shijun

doi:10.1007/s00405-016-4127-x

Cited by 35 publications

(39 citation statements)

References 24 publications

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“…This result is partially consistent with several previous studies (Duan et al, 2016, Lv et al, 2014). Duan et al (2016) detected lower fractional anisotropy (FA) in the frontal and parietal WM in the post-RT-ED group than that of the pre-RT group. Lv et al (2014) found GM volume deficit in the parietal cortex in NPC patients after RT.…”

Section: Discussionsupporting

confidence: 94%

“…In the post-RT-ED group, we have not found significantly changed cortical thickness in the temporal region, but previous DTI studies (Duan et al, 2016, Xiong et al, 2013) have detected abnormal temporal region in the post-RT-ED group. For example, using DTI method, Duan et al (2016) found higher mean diffusivity in the bilateral temporal regions in the post-RT-ED group than that of the pre-RT group.…”

Section: Discussioncontrasting

confidence: 93%

“…For example, using DTI method, Duan et al (2016) found higher mean diffusivity in the bilateral temporal regions in the post-RT-ED group than that of the pre-RT group. Xiong et al (2013) detected lower FA in the temporal region in the post-RT-ED group than that of the pre-RT group.…”

Section: Discussionmentioning

confidence: 95%

“…Based on the onset time of symptom, the typical brain response to RT has been divided into three periods, the acute reaction period (few days to few weeks), early delayed radiation period (1–6 months), and late delayed radiation period (6 months to few years) (Duan et al, 2016, Moretti et al, 2005, New, 2001). To explore the effect of RT on brain structure in different periods, we sub-classified all of the 42 post-RT patients in the present study into two groups.…”

Section: Methodsmentioning

confidence: 99%

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Radiation-induced abnormal cortical thickness in patients with nasopharyngeal carcinoma after radiotherapy

Lin

Niu

et al. 2017

NeuroImage: Clinical

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Conventional MRI studies showed that radiation-induced brain necrosis in patients with nasopharyngeal carcinoma (NPC) in years after radiotherapy (RT) could involve brain gray matter (GM) and impair brain function. However, it is still unclear the radiation-induced brain morphological changes in NPC patients with normal-appearing GM in the early period after RT. In this study, we acquired high-resolution brain structural MRI data from three groups of patients, 22 before radiotherapy (pre-RT) NPC patients with newly diagnosed but not yet medically treated, 22 NPC patients in the early-delayed stage after radiotherapy (post-RT-ED), and 20 NPC patients in the late-delayed stage after radiotherapy (post-RT-LD), and then analyzed the radiation-induced cortical thickness alteration in NPC patients after RT. Using a vertex-wise surface-based morphometry (SBM) approach, we detected significantly decreased cortical thickness in the precentral gyrus (PreCG) in the post-RT-ED group compared to the pre-RT group. And the post-RT-LD group showed significantly increased cortical thickness in widespread brain regions, including the bilateral inferior parietal, left isthmus of the cingulate, left bank of the superior temporal sulcus and left lateral occipital regions, compared to the pre-RT group, and in the bilateral PreCG compared to the post-RT-ED group. Similar analysis with ROI-wise SBM method also found the consistent results. These results indicated that radiation-induced brain injury mainly occurred in the post-RT-LD group and the cortical thickness alterations after RT were dynamic in different periods. Our findings may reflect the pathogenesis of radiation-induced brain injury in NPC patients with normal-appearing GM and an early intervention is necessary for protecting GM during RT.

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Section: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

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Radiation-induced abnormal cortical thickness in patients with nasopharyngeal carcinoma after radiotherapy

Lin

Niu

et al. 2017

NeuroImage: Clinical

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“…For instance, an MRS study (Chen et al, 2014) found dynamic and transient metabolic alterations in the temporal lobe. Using TBSS, one DTI study demonstrated dynamic and complex WM microstructural changes in the earlier phases of RT (Duan et al, 2016). A multimodal study combining MRS and DTI (Xiong et al, 2013) reported significant alterations in both the metabolic and diffusion parameters of the WM that appeared normal in the temporal lobe.…”

Section: Introductionmentioning

confidence: 99%

Cortical Surface Area Rather Than Cortical Thickness Potentially Differentiates Radiation Encephalopathy at Early Stage in Patients With Nasopharyngeal Carcinoma

Zhang

Chen

et al. 2018

Front. Neurosci.

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Radiation encephalopathy (RE) is one of the most severe complications in nasopharyngeal carcinoma (NPC) patients after radiotherapy (RT). However, the morphological alteration of early RE is insufficiently investigated. We aimed to investigate the cortical thickness and surface area alterations in NPC patients with or without RE in the follow-up. A total of 168 NPC patients each underwent a single scan and analysis at various times either Pre-RT (n = 56) or Post-RT (n = 112). We further divided the Post-RT NPC patients into three groups based on the time of the analysis following RT (Post-RTwithin 6 months and Post-RT7-12 months) or whether RE signs were detected in the analysis (Post-RTRE proved in follow-up). We confined the vertex-wise analyses of the cortical thickness and surface area to the bilateral temporal lobes. Interestingly, we revealed a gradual increase in the cortical surface area of the temporal lobe with increasing time after RT within the Post-RTRE proved in follow-up group, consistent with the between-group findings, which showed a significant increase in cortical surface area in the Post-RTRE proved in follow-up group relative to the Pre-RT group and the Post-RTwithin 6 months group. By contrast, such a trend was not observed in the cortical thickness findings. We concluded that the cortical surface area, rather than cortical thickness, may serve as a potential biomarker for early diagnosis of RE.

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Early‐Onset Micromorphological Changes of Neuronal Fiber Bundles During Radiotherapy

Liu

Wang

Zhou

et al. 2021

Magnetic Resonance Imaging

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Background Patients receiving cranial radiation face the risk of delayed brain dysfunction. However, an early medical imaging marker is not available until irreversible morphological changes emerge. Purpose To explore the micromorphological white matter changes during the radiotherapy session by utilizing an along‐tract analysis framework. Study Type Prospective. Population Eighteen nasopharyngeal carcinoma (two female) patients receiving cranial radiation. Field Strength/Sequence 3.0 T; Diffusion tensor imaging (DTI) and T1‐ and T2‐weighted images (T1W, T2W); computed tomography (CT). Assessment Patients received three DTI imaging scans during the radiotherapy (RT), namely the baseline scan (1–2 days before RT began), the middle scan (the middle of the RT session), and the end scan (1–2 days after RT ended). Twelve fibers were segmented after whole‐brain tractography. Then, the fractional anisotropy (FA) values and the cumulative radiation dose received for each fiber streamline were resampled and projected into their center fiber. Statistical Tests The contrast among the three scans (P1: middle scan–baseline scan; P2: end scan–middle scan; P3: end scan–baseline scan) were compared using the linear mixed model for each of the 12 center fibers. Then, a dose–responsiveness relationship was performed using Pearson correlation. P < 0.05 was considered statistically significant. Results Six of the 12 center fibers showed significant changes of FA values during the RT but with heterogeneous patterns. The significant changes along a specific center fiber were associated with their cumulative dose received (Genu: P1 r = −0.6182, P2 r = −0.5907; Splenium: P1 r = 0.4055, P = 0.1063, P2 r = 0.6742; right uncinate fasciculus: P1 r = −0.3865, P2 r = −0.4912, P = 0.0533; right corticospinal tract: P1 r = 0.4273, P = 0.1122, P2 r = −0.6885). Data Conclusion The along‐tract analysis might provide sensitive measures on the early‐onset micromorphological changes. Level of Evidence 2 Technical Efficacy Stage 3

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Whole-brain changes in white matter microstructure after radiotherapy for nasopharyngeal carcinoma: a diffusion tensor imaging study

Cited by 35 publications

References 24 publications

Radiation-induced abnormal cortical thickness in patients with nasopharyngeal carcinoma after radiotherapy

Radiation-induced abnormal cortical thickness in patients with nasopharyngeal carcinoma after radiotherapy

Cortical Surface Area Rather Than Cortical Thickness Potentially Differentiates Radiation Encephalopathy at Early Stage in Patients With Nasopharyngeal Carcinoma

Early‐Onset Micromorphological Changes of Neuronal Fiber Bundles During Radiotherapy

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