Responses in the diffusivity and vascular function of the irradiated normal brain are seen up until 18 months following SRS of brain metastases
Responses in the diffusivity and vascular function of the irradiated normal brain are seen up until 18 months following SRS of brain metastases
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脑转移瘤接受 SRS 治疗后 18 个月内，受辐射的正常大脑的扩散率和血管功能都会出现反应
DOI：
10.1093/noajnl/vdaa028
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
K. Emblem
中科院分区：
文献类型：
--
作者：
L. Nilsen;I. Digernes;E. Grøvik;C. Saxhaug;A. Latysheva;O. Geier;B. Breivik;D. O. Sætre;K. Jacobsen;Å. Helland;K. Emblem
摘要 背景 MRI 可以深入了解脑转移瘤立体定向放射外科 (SRS) 后受辐射的正常大脑的扩散率和血管功能的纵向反应。方法 40 例非小细胞肺癌 (N = 26) 和恶性黑色素瘤 (N = 14) 脑转移患者接受 SRS (15-25 Gy)。在 SRS 前和 SRS 后 3、6、9、12 和 18 个月进行纵向 MRI。组织扩散率和血管分布的测量分别通过扩散加权和灌注 MRI 进行评估。所有图均针对接受少于 1 Gy 的白质进行归一化。在低剂量（1-10 Gy）和高剂量（>10 Gy）区域评估正常大脑（排除肿瘤和水肿）的纵向反应。在 SRS 之前记录东部肿瘤合作组 (ECOG) 的表现状态。结果 SRS 后，低剂量区域的扩散率持续增加 1 年（105.1% ± 6.2%；P < .001），然后在 18 个月时恢复到 SRS 前的水平。在 SRS 后 6-9 个月，低剂量组观察到微血管脑血容量 (P < .05)、血流量 (P < .05) 和血管密度 (P < .05) 短暂减少。相应地，低剂量的血管口径在 3-9 个月时短暂增加 (P < .01)。 HighDose 中的反应显示出与 LowDose 中相似的趋势，但患者间差异更大。血管反应遵循 SRS 前的 ECOG 状态。结论 我们的结果表明，即使在脑 SRS 后对正常大脑进行低剂量的辐射，也会导致扩散性增加和血管功能降低，持续时间长达 18 个月。特别是，血管反应表明正常的脑组织形成新毛细血管的能力下降。有必要评估 SRS 对正常大脑的潜在长期神经系统影响。
Abstract Background MRI may provide insights into longitudinal responses in the diffusivity and vascular function of the irradiated normal-appearing brain following stereotactic radiosurgery (SRS) of brain metastases. Methods Forty patients with brain metastases from non-small cell lung cancer (N = 26) and malignant melanoma (N = 14) received SRS (15–25 Gy). Longitudinal MRI was performed pre-SRS and at 3, 6, 9, 12, and 18 months post-SRS. Measures of tissue diffusivity and vascularity were assessed by diffusion-weighted and perfusion MRI, respectively. All maps were normalized to white matter receiving less than 1 Gy. Longitudinal responses were assessed in normal-appearing brain, excluding tumor and edema, in the LowDose (1–10 Gy) and HighDose (>10 Gy) regions. The Eastern Cooperative Oncology Group (ECOG) performance status was recorded pre-SRS. Results Following SRS, the diffusivity in the LowDose region increased continuously for 1 year (105.1% ± 6.2%; P < .001), before reversing toward pre-SRS levels at 18 months. Transient reductions in microvascular cerebral blood volume (P < .05), blood flow (P < .05), and vessel densities (P < .05) were observed in LowDose at 6–9 months post-SRS. Correspondingly, vessel calibers in LowDose transiently increased at 3–9 months (P < .01). The responses in HighDose displayed similar trends as in LowDose, but with larger interpatient variations. Vascular responses followed pre-SRS ECOG status. Conclusions Our results imply that even low doses of radiation to normal-appearing brain following cerebral SRS induce increased diffusivity and reduced vascular function for up until 18 months. In particular, the vascular responses indicate the reduced ability of the normal-appearing brain tissue to form new capillaries. Assessing the potential long-term neurologic effects of SRS on the normal-appearing brain is warranted.
影响因子：
3.5
作者：
Brenner, David J.
通讯作者：
Brenner, David J.
影响因子：
2.3
作者：
Sundgren PC;Cao Y
通讯作者：
Cao Y
DOI：
10.1016/j.ijrobp.2011.01.068
发表时间：
2012-04-01
影响因子：
7
作者：
Chapman, Christopher H.;Nagesh, Vijaya;Sundgren, Pia C.;Buchtel, Henry;Chenevert, Thomas L.;Junck, Larry;Lawrence, Theodore S.;Tsien, Christina I.;Cao, Yue
通讯作者：
Cao, Yue