Serial diffusion tensor imaging for early detection of radiation‐induced injuries to normal‐appearing white matter in high‐grade glioma patients

Hope, Tuva Roaldsdatter; Vardal, Jonas; Bjørnerud, Atle; Larsson, Christopher; Arnesen, Marius Røthe; Salo, Raimo A.; Groote, Inge Rasmus

doi:10.1002/jmri.24533

Cited by 35 publications

(31 citation statements)

References 48 publications

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“…DTI studies have been conducted in both adult and pediatric patients treated by either whole (7, 8) or partial brain RT (9-14), but only in selected WM structures, for example, corpus callosum (9) and corticospinal tracts (14). Overall, it is found that DTI changes are progressive over time and dose-dependent (9-12). Furthermore, a recent study showed a correlation between early diffusivity changes in the parahippocampal cingulum and a late decline in verbal recall (11).…”

Section: Introductionmentioning

confidence: 94%

Effect of the Maximum Dose on White Matter Fiber Bundles Using Longitudinal Diffusion Tensor Imaging

Zhu

Chapman

Tsien

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose Previous efforts to decrease neurocognitive effects of radiation focused on sparing isolated cortical structures. We hypothesize that understanding temporal, spatial and dosimetric patterns of radiation damage of whole brain white matter (WBWM) after partial brain irradiation might also be important. Therefore, we carried out a study to develop the methodology to assess radiotherapy-induced damage to WBWM bundles. Methods An atlas-based, automated WM tractography analysis was implemented to quantify longitudinal changes in indices of diffusion tensor imaging (DTI) of 22 major WM fibers in 33 patients with predominantly low-grade/benign brain tumors treated by radiotherapy. Six DTI scans per patient were performed from pre-RT to 18 months post-RT. The DTI indices and planned doses (maximum and mean doses) were mapped onto profiles of each of 22 WM bundles. A multivariate linear regression was performed to determine the main dose effect as well as the influence of other clinical factors on longitudinal percentage changes in axial and radial diffusivity (AD and RD) from pre-RT. Results Of 22 fiber bundles, AD/RD changes in 12 bundles were affected significantly by doses (P<0.05), as the effect was progressive over time. In nine elongated tracts, decreased AD/RD was significantly related to maximum doses received, consistent with a serial-structure. In individual bundles, AD changes were up to 11.5% at the maximum dose locations 18 months post-RT. The dose effect on WM was greater in older females than younger males. Conclusion Our study demonstrates for the first time that the maximum dose to the elongated WM bundles causes post-radiotherapy damage in WM. Validation and correlative studies are necessary to determine the ability and impact of sparing these bundles on preserving neurocognitive function post-radiotherapy.

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Section: Introductionmentioning

confidence: 94%

Effect of the Maximum Dose on White Matter Fiber Bundles Using Longitudinal Diffusion Tensor Imaging

Zhu

Chapman

Tsien

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Decreases in FA [18, 19, 30-32] and increases in AD, and RD [18, 33] have been observed in brain tumor patients treated with radiation. Unfortunately, the literature is sparse when it comes to the effects of surgery and chemotherapy on white matter integrity.…”

Section: Discussionmentioning

confidence: 99%

Long-term effects of radiation therapy on white matter of the corpus callosum: a diffusion tensor imaging study in children

et al. 2017

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Background Despite improving survival rates, children are at risk for long-term cognitive and behavioral difficulties following the diagnosis and treatment of a brain tumor. Surgery, chemotherapy and radiation therapy have all been shown to impact the developing brain, especially the white matter. Objective The purpose of this study was to determine the long-term effects of radiation therapy on white matter integrity, as measured by diffusion tensor imaging, in pediatric brain tumor patients two years after the end of radiation treatment, while controlling for surgical interventions. Materials and Methods We evaluated diffusion tensor imaging performed at two time points: a baseline three to twelve months after surgery and a follow-up approximately two years later in pediatric brain tumor patients. A region of interest analysis was performed within three regions of the corpus callosum. Diffusion tensor metrics were determined for participants (N=22) who underwent surgical tumor resection and radiation therapy and demographically matched with participants (N=22) who received surgical tumor resection only. Results Analysis revealed that at two years post treatment, the radiation treated group exhibited significantly lower fractional anisotropy and significantly higher radial diffusivity within the body of the corpus callosum compared to the group that did not receive radiation. Conclusion The findings indicate that pediatric brain tumor patients treated with radiation therapy may be at greater risk of experiencing long-term damage to the body of the corpus callosum than those treated with surgery alone.

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“…The mechanisms for radiation-induced cognitive impairments remain obscure. In addition to disrupted neurogenesis and chronic inflammatory responses,47 radiotherapy is associated with a greater incidence of WM hyperintensities and may induce subtle progressive WM disturbance 48. Crucially, careful surgical preservation of tracts may theoretically be undone if radiotherapy compromises important proximal tracts.…”

Section: Relevance Of White Matter In Neuro-oncological Treatmentmentioning

confidence: 99%

Brain white matter fibre tracts: a review of functional neuro-oncological relevance

Voets

Bartsch

Plaha

2017

J Neurol Neurosurg Psychiatry

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State-of-the-art glioma treatment aims to maximise neuro-oncological benefit while minimising losses in quality of life. Optimising this balance remains hindered by our still limited understanding of information processing in the human brain. To help understand individual differences in functional outcomes following neuro-oncological treatment, we review mounting evidence demonstrating the fundamental role that white matter connections play in complex human behaviour. We focus on selected fibre tracts whose destruction is recognised to elicit predictable behavioural deficits and consider specific indications for non-invasive diffusion MRI tractography, the only existing method to map these fibre tracts in vivo, in the selection and planning of neuro-oncological treatments. Despite remaining challenges, longitudinal tract imaging, in combination with intraoperative testing and neuropsychological evaluation, offers unique opportunities to refine our understanding of human brain organisation in the quest to predict and ultimately reduce the quality of life burden of both surgical and non-surgical first-line neuro-oncological therapies.

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Serial diffusion tensor imaging for early detection of radiation‐induced injuries to normal‐appearing white matter in high‐grade glioma patients

Abstract: DTI is not sensitive to acute global NAWM changes during the treatment of HGG, but sensitive to early posttreatment changes.

Cited by 35 publications

References 48 publications

Effect of the Maximum Dose on White Matter Fiber Bundles Using Longitudinal Diffusion Tensor Imaging

Effect of the Maximum Dose on White Matter Fiber Bundles Using Longitudinal Diffusion Tensor Imaging

Long-term effects of radiation therapy on white matter of the corpus callosum: a diffusion tensor imaging study in children

Brain white matter fibre tracts: a review of functional neuro-oncological relevance

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