Michael Connor1, Roshan Karunamuni2, Carrie McDonald3, Nathan White4, Niclas Pettersson1, Vitali Moiseenko1, Tyler Seibert2, Deborah Marshall1, Laura Cervino1, Hauke Bartsch4, Joshua Kuperman4, Vyacheslav Murzin1, Anitha Krishnan4, Nikdokht Farid4, Anders Dale5, Jona Hattangadi-Gluth6. 1. Department of Radiation Medicine and Applied Sciences, University of California San Diego, United States. 2. Department of Radiation Medicine and Applied Sciences, University of California San Diego, United States; Multimodal Imaging Laboratory, University of California San Diego, United States. 3. Department of Radiation Medicine and Applied Sciences, University of California San Diego, United States; Department of Psychiatry, University of California San Diego, United States; Multimodal Imaging Laboratory, University of California San Diego, United States. 4. Department of Radiology, University of California San Diego, United States; Multimodal Imaging Laboratory, University of California San Diego, United States. 5. Department of Radiology, University of California San Diego, United States; Department of Psychiatry, University of California San Diego, United States; Department of Neurosciences, University of California San Diego, United States; Multimodal Imaging Laboratory, University of California San Diego, United States. 6. Department of Radiation Medicine and Applied Sciences, University of California San Diego, United States; Multimodal Imaging Laboratory, University of California San Diego, United States. Electronic address: jhattangadi@ucsd.edu.
Abstract
BACKGROUND AND PURPOSE: Brain radiotherapy is limited in part by damage to white matter, contributing to neurocognitive decline. We utilized diffusion tensor imaging (DTI) with multiple b-values (diffusion weightings) to model the dose-dependency and time course of radiation effects on white matter. MATERIALS AND METHODS: Fifteen patients with high-grade gliomas treated with radiotherapy and chemotherapy underwent MRI with DTI prior to radiotherapy, and after months 1, 4-6, and 9-11. Diffusion tensors were calculated using three weightings (high, standard, and low b-values) and maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ∥), and radial diffusivity (λ⊥) were generated. The region of interest was all white matter. RESULTS: MD, λ∥, and λ⊥ increased significantly with time and dose, with corresponding decrease in FA. Greater changes were seen at lower b-values, except for FA. Time-dose interactions were highly significant at 4-6months and beyond (p<.001), and the difference in dose response between high and low b-values reached statistical significance at 9-11months for MD, λ∥, and λ⊥ (p<.001, p<.001, p=.005 respectively) as well as at 4-6months for λ∥ (p=.04). CONCLUSIONS: We detected dose-dependent changes across all doses, even <10Gy. Greater changes were observed at low b-values, suggesting prominent extracellular changes possibly due to vascular permeability and neuroinflammation. Copyright Â
BACKGROUND AND PURPOSE: Brain radiotherapy is limited in part by damage to white matter, contributing to neurocognitive decline. We utilized diffusion tensor imaging (DTI) with multiple b-values (diffusion weightings) to model the dose-dependency and time course of radiation effects on white matter. MATERIALS AND METHODS: Fifteen patients with high-grade gliomas treated with radiotherapy and chemotherapy underwent MRI with DTI prior to radiotherapy, and after months 1, 4-6, and 9-11. Diffusion tensors were calculated using three weightings (high, standard, and low b-values) and maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ∥), and radial diffusivity (λ⊥) were generated. The region of interest was all white matter. RESULTS: MD, λ∥, and λ⊥ increased significantly with time and dose, with corresponding decrease in FA. Greater changes were seen at lower b-values, except for FA. Time-dose interactions were highly significant at 4-6months and beyond (p<.001), and the difference in dose response between high and low b-values reached statistical significance at 9-11months for MD, λ∥, and λ⊥ (p<.001, p<.001, p=.005 respectively) as well as at 4-6months for λ∥ (p=.04). CONCLUSIONS: We detected dose-dependent changes across all doses, even <10Gy. Greater changes were observed at low b-values, suggesting prominent extracellular changes possibly due to vascular permeability and neuroinflammation. Copyright Â
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