Longitudinal Assessment of Chemotherapy-Induced Structural Changes in Cerebral White Matter and Its Correlation With Impaired Cognitive Functioning
Longitudinal Assessment of Chemotherapy-Induced Structural Changes in Cerebral White Matter and Its Correlation With Impaired Cognitive Functioning
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DOI：
10.1200/jco.2011.36.8571
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发表时间：
2012-01-20
影响因子：
45.3
通讯作者：
Sunaert, Stefan
中科院分区：
文献类型：
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作者：
Deprez, Sabine;Amant, Frederic;Sunaert, Stefan
目的探讨辅助化疗相关认知功能损害的神经机制，我们研究了化疗前后脑白色物质（WM）的完整性，采用磁共振弥散张量成像（DTI）结合详细的认知评估。在化疗开始前（t1）和治疗后3 - 4个月（t2），对接受化疗的20 - 30岁乳腺癌患者进行神经心理学测试和DTI。16名未接受化疗的患者和19名年龄匹配的健康对照者在匹配的时间间隔接受了相同的评估。在所有组中，我们使用配对t检验来研究神经心理学测试分数的变化，并使用基于全脑体素的配对t检验来研究WM分数各向异性（FA;反映WM组织组织结构的DTI测量）的变化，并将抑郁评分和智商作为协变量。我们相关的神经心理学测试分数的变化与FA的平均变化的地区，幸存的配对t检验的患者接受chemicals.ResultsIn对比对照组，化疗治疗组的注意力测试，psychological速度，记忆力在t2与t1（P < .05）相比，显着恶化。在化疗组中，我们发现治疗后额叶、顶叶和枕叶WM束的FA显著降低（家族误差P <0.05），而对于两个对照组，FA值在t1和t2之间是相同的。此外，在化疗治疗的patients（P <0.05），平均区域FA的变化与注意力和言语记忆的性能变化相关（P < .05）。
PurposeTo uncover the neural substrate of cognitive impairment related to adjuvant chemotherapy, we studied cerebral white matter (WM) integrity before and after chemotherapy by using magnetic resonance diffusion tensor imaging (DTI) in combination with detailed cognitive assessment.Patients and MethodsThirty-four young premenopausal women with early-stage breast cancer who were exposed to chemotherapy underwent neuropsychologic testing and DTI before the start of chemotherapy (t1) and 3 to 4 months after treatment (t2). Sixteen patients not exposed to chemotherapy and 19 age-matched healthy controls underwent the same assessment at matched intervals. In all groups, we used paired t tests to study changes in neuropsychologic test scores and whole-brain voxel-based paired t tests to study changes in WM fractional anisotropy (FA; a DTI measure that reflects WM tissue organization), with depression scores and intelligence quotient as included covariates. We correlated changes of neuropsychologic test scores with the mean change of FA for regions that survived the paired t tests in patients treated with chemotherapy.ResultsIn contrast to controls, the chemotherapy-treated group performed significantly worse on attention tests, psychomotor speed, and memory at t2 compared with t1 (P < .05). In the chemotherapy-treated group, we found significant decreases of FA in frontal, parietal, and occipital WM tracts after treatment (familywise error P < .05), whereas for both control groups, FA values were the same between t1 and t2. Furthermore, performance changes in attention and verbal memory correlated with mean regional FA changes in chemotherapy-treated patients (P < .05).ConclusionWe report evidence of longitudinal changes in cognitive functioning and cerebral WM integrity after chemotherapy as well as an association between both.