Michael Connor1, Roshan Karunamuni2, Carrie McDonald3, Tyler Seibert2, Nathan White4, Vitali Moiseenko1, Hauke Bartsch4, Nikdokht Farid4, Joshua Kuperman4, Anitha Krishnan4, Anders Dale5, Jona A Hattangadi-Gluth6. 1. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States. 2. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States; Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, United States. 3. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States; Department of Psychiatry, University of California San Diego, La Jolla, California, United States; Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, United States. 4. Department of Radiology, University of California San Diego, La Jolla, California, United States; Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, United States. 5. Department of Radiology, University of California San Diego, La Jolla, California, United States; Department of Psychiatry, University of California San Diego, La Jolla, California, United States; Department of Neurosciences, University of California San Diego, La Jolla, California, United States; Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, United States. 6. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States; Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, United States. Electronic address: jhattangadi@ucsd.edu.
Abstract
BACKGROUND AND PURPOSE: Regional differences in sensitivity to white matter damage after brain radiotherapy (RT) are not well-described. We characterized the spatial heterogeneity of dose-response across white matter tracts using diffusion tensor imaging (DTI). MATERIALS AND METHODS: Forty-nine patients with primary brain tumors underwent MRI with DTI before and 9-12months after partial-brain RT. Maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were generated. Atlas-based white matter tracts were identified. A secondary analysis using skeletonized tracts was also performed. Linear mixed-model analysis of the relationship between mean and max dose and percent change in DTI metrics was performed. RESULTS: Tracts with the strongest correlation of FA change with mean dose were the fornix (-0.46 percent/Gy), cingulum bundle (-0.44 percent/Gy), and body of corpus callosum (-0.23 percent/Gy), p<.001. These tracts also showed dose-sensitive changes in MD and RD. In the skeletonized analysis, the fornix and cingulum bundle remained highly dose-sensitive. Maximum and mean dose were similarly predictive of DTI change. CONCLUSIONS: The corpus callosum, cingulum bundle, and fornix show the most prominent dose-dependent changes following RT. Future studies examining correlation with cognitive functioning and potential avoidance of critical white matter regions are warranted.
BACKGROUND AND PURPOSE: Regional differences in sensitivity to white matter damage after brain radiotherapy (RT) are not well-described. We characterized the spatial heterogeneity of dose-response across white matter tracts using diffusion tensor imaging (DTI). MATERIALS AND METHODS: Forty-nine patients with primary brain tumors underwent MRI with DTI before and 9-12months after partial-brain RT. Maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were generated. Atlas-based white matter tracts were identified. A secondary analysis using skeletonized tracts was also performed. Linear mixed-model analysis of the relationship between mean and max dose and percent change in DTI metrics was performed. RESULTS: Tracts with the strongest correlation of FA change with mean dose were the fornix (-0.46 percent/Gy), cingulum bundle (-0.44 percent/Gy), and body of corpus callosum (-0.23 percent/Gy), p<.001. These tracts also showed dose-sensitive changes in MD and RD. In the skeletonized analysis, the fornix and cingulum bundle remained highly dose-sensitive. Maximum and mean dose were similarly predictive of DTI change. CONCLUSIONS: The corpus callosum, cingulum bundle, and fornix show the most prominent dose-dependent changes following RT. Future studies examining correlation with cognitive functioning and potential avoidance of critical white matter regions are warranted.
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