Brain tumor therapy-induced changes in normal-appearing brainstem measured with longitudinal diffusion tensor imaging.
Brain tumor therapy-induced changes in normal-appearing brainstem measured with longitudinal diffusion tensor imaging.
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DOI：
10.1016/j.ijrobp.2011.03.057
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发表时间：
2012-04-01
影响因子：
7
通讯作者：
Ogg, Robert J.
中科院分区：
文献类型：
--
作者：
Hua, Chiaho;Merchant, Thomas E.;Gajjar, Amar;Broniscer, Alberto;Zhang, Yong;Li, Yimei;Glenn, George R.;Kun, Larry E.;Ogg, Robert J.
通过序列扩散张量成像（DTI）描述儿童脑肿瘤患者治疗引起的正常脑干变化。我们分析了20例脑肿瘤患者的109项DTI研究，年龄在4 - 23岁之间，治疗区域包括正常脑干。髓母细胞瘤、幕上原始神经外胚层肿瘤和非典型畸胎瘤样横纹肌样瘤（n = 10）接受术后颅脊髓照射（23.4 - 39.6戈伊），原发部位累积剂量为55.8戈伊，随后接受4个周期的大剂量化疗。高级别胶质瘤患者（n = 10）在放疗期间和放疗后（54 - 59.4戈伊）接受厄洛替尼治疗。计算分数各向异性（FA）和表观扩散系数（ADC）的参数图，并将其空间配准到三维辐射剂量数据。感兴趣的区域包括皮质脊髓束、内侧丘系和脑桥。作为与年龄相关的比较基准，来自20名6 - 25岁健康志愿者的37项DTI研究被纳入分析。中位DTI随访时间为3.5年（范围：1.6 - 5.0年）。脑桥的中位平均剂量为56戈伊（范围，7 - 59戈伊）。在纵向FA和ADC变化中观察到三种模式：稳定或正常的发展时间趋势，初始偏离正常随后恢复，以及无完全恢复证据的进行性偏离。FA的最大下降通常发生在放射治疗开始后1.5至3.5年。4年内可观察到完全恢复时间趋势。不完全恢复的患者通常在第一年内FA下降幅度较大。辐射剂量本身并不能预测长期的恢复模式。治疗后脑干白色物质损伤和恢复的纵向演变存在个体差异。脑干各向异性的早期反应可以作为放射治疗后5年内恢复时间趋势的指标。
To characterize therapy-induced changes in normal-appearing brainstems of childhood brain tumor patients by serial diffusion tensor imaging (DTI). We analyzed 109 DTI studies from 20 brain tumor patients, aged 4-23 years, with normal-appearing brainstems included in the treatment fields. Those with medulloblastomas, supratentorial primitive neuroectodermal tumors and atypical teratoid rhabdoid tumors (n=10) received postoperative craniospinal irradiation (23.4-39.6 Gy) and a cumulative dose of 55.8 Gy to the primary site, followed by 4 cycles of high-dose chemotherapy. Patients with high-grade gliomas (n=10) received erlotinib during and after irradiation (54-59.4 Gy). Parametric maps of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were computed and spatially registered to three-dimensional radiation dose data. Volumes of interest included corticospinal tracts, medial lemnisci, and the pons. Serving as an age-related benchmark for comparison, 37 DTI studies from 20 healthy volunteers, aged 6-25 years, were included in the analysis. The median DTI follow-up was 3.5 years (range, 1.6-5.0 years). The median mean dose to the pons was 56 Gy (range, 7-59 Gy). Three patterns were seen in longitudinal FA and ADC changes: a stable or normal developing time trend, initial deviation from normal with subsequent recovery, and progressive deviation without evidence of complete recovery. The maximal decline in FA often occurred 1.5 to 3.5 years after the start of radiation therapy. A full recovery time trend could be observed within 4 years. Patients with incomplete recovery often had a larger decline in FA within the first year. Radiation dose alone did not predict long-term recovery patterns. Variation existed among individual patients after therapy in longitudinal evolution of brainstem white matter injury and recovery. Early response in brainstem anisotropy may serve as an indicator of the recovery time trend over 5 years following radiation therapy.
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影响因子：
5.8
作者：
Chanraud, Sandra;Zahr, Natalie;Sullivan, Edith V.;Pfefferbaum, Adolf
通讯作者：
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DOI：
10.1016/s0360-3016(01)01599-1
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