Value of 3D-ASL, MRS and DTI in the diagnosis and treatment of radiation-induced temporal lobe injury of nasopharyngeal carcinoma

doi:10.3760/cma.j.cn371439-20200603-00076

Abstract

Abstract:

Radiotherapy is the main treatment of nasopharyngeal carcinoma (NPC). With the continuous improvement of radiotherapy technology, the survival time of NPC patients is significantly improved, but the complications after radiotherapy have been paid more and more attention, in which the incidence of radiation-induced temporal lobe injury is higher, which seriously affects the quality of life of patients, and even reduces the survival rate. Therefore, it is particularly important to find a method for the examination of early radiation-induced temporal lobe injury. Three-dimensional arterial spin labeling (3D-ASL) analysis of cerebral blood flow (CBF) changes before and after radiotherapy, magnetic resonance spectroscopy (MRS) analysis to determine the changes of NAA/Cr, Cho/NAA, Cho/Cr ratio in the anterior and posterior temporal lobe before and after radiotherapy, and diffusion tensor imaging (DTI) to determine the changes of temporal lobe average diffusion coefficient (ADC) and anisotropy fraction (FA) before and after radiotherapy can help in the early diagnosis of radiation brain injury, especially through the combined use of the above three tests. It is expected to provide a feasible basis for the early diagnosis of radiation encephalopathy, and early nutritional neurotherapy is of great significance to improve the quality of life and survival rate of patients.

Key words: Magnetic resonance imaging, Nasopharyngeal neoplasms, Therapy, Radioactive temporal lobe damage

Yang Minghui, Jin Feng. Value of 3D-ASL, MRS and DTI in the diagnosis and treatment of radiation-induced temporal lobe injury of nasopharyngeal carcinoma[J]. Journal of International Oncology, 2020, 47(9): 550-554.

References 38

[1]	Feng M, Huang Y, Fan X, et al. Prognostic variables for temporal lobe injury after intensity modulated-radiotherapy of nasopharyngeal carcinoma[J]. Cancer Med, 2018,7(3):557-564. DOI: 10.002/cam4.1291. doi: 10.1002/cam4.1291 pmid: 29473319
[2]	Pan XB, Liu Y, Huang ST, et al. Predictors for improvement of xerostomia in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy[J]. Medicine (Baltimore), 2019,98(36):e17030. DOI: 10.1097/MD.0000000000017030. doi: 10.1097/MD.0000000000017030
[3]	潘才住, 杨凌, 马礼钦, 等. 磁共振弥散加权成像评价唾液腺放射性损伤的可行性[J]. 中华肿瘤防治杂志, 2015,22(20):1619-1623. DOI: 10.16073/j.cnki.cjcpt.2015.20.008.
[4]	Yang Y, Lin X, Li J, et al. Aberrant brain activity at early delay stage post-radiotherapy as a biomarker for predicting neurocognitive dysfunction late-delayed in patients with nasopharyngeal carcinoma[J]. Front Neurol, 2019,10:752. DOI: 10.3389/fneur.2019.00752. doi: 10.3389/fneur.2019.00752 pmid: 31379710
[5]	Perry A, Schmidt RE. Cancer therapy-associated CNS neuropathology: an update and review of the literature[J]. Acta Neuropathol, 2006,111(3):197-212. DOI: 10.1007/s00401-005-0023-y. doi: 10.1007/s00401-005-0023-y
[6]	郭业松, 黄生富, 何侠. 鼻咽癌调强放疗后放射性颞叶损伤32例临床分析[J]. 肿瘤学杂志, 2017,23(10):910-913. DOI: 10.11735/j.issn.1671-170X.2017.10.B015.
[7]	Makale MT McDonald CR Hattangadi-Gluth JA, et al. Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours[J]. Nat Rev Neurol, 2017,13(1):52-64. DOI: 10.1038/nrneurol.2016.185. doi: 10.1038/nrneurol.2016.185 pmid: 27982041
[8]	Xiong WF, Qiu SJ, Wang HZ, et al. ¹H-MR spectroscopy and diffusion tensor imaging of normal-appearing temporal white matter in patients with nasopharyngeal carcinoma after irradiation: initial experience [J]. J Magn Reson Imaging, 2013,37(1):101-108. DOI: 10.1002/jmri.23788. doi: 10.1002/jmri.23788
[9]	Haller S, Zaharchuk G, Thomas DL, et al. Arterial spin labeling perfusion of the brain: emerging clinical applications[J]. Radiology, 2016,281(2):337-356. DOI: 10.1148/radiol.2016150789. doi: 10.1148/radiol.2016150789 pmid: 27755938
[10]	潘高升, 刘干辉, 陈振松. 3.0MR动脉自旋标记技术在研究鼻咽癌放疗后的初步研究[J]. 现代医用影像学, 2019,28(11):2361-2363.
[11]	马进, 张翱. 3D-ASL技术的研究进展及临床应用[J]. 国际医学放射学杂志, 2015,38(1):50-53. DOI: 10.3874/j.issn.1674-1897.2015.01.Z0111.
[12]	Abdel Razek AAK, Nada N. Arterial spin labeling perfusion-weighted MR imaging: correlation of tumor blood flow with pathological degree of tumor differentiation, clinical stage and nodal metastasis of head and neck squamous cell carcinoma[J]. Eur Arch Otorhino-laryngol, 2018,275(5):1301-1307. DOI: 10. 1007/s00405-018-4950-3.
[13]	王继民, 叶向阳, 赵伟, 等. 磁共振动脉自旋标记成像对鼻咽癌放疗后颞叶早期放射性脑损伤的诊断价值[J]. 实用临床医药杂志, 2016,20(15):196-197, 201. DOI: 10.7619/jcmp.201615075.
[14]	Ye J, Bhagat SK, Li H, et al. Differentiation between recurrent gliomas and radiation necrosis using arterial spin labeling perfusion imaging[J]. Exp Ther Med, 2016,11(6):2432-2436. DOI: 10.3892/etm.2016.3225. doi: 10.3892/etm.2016.3225 pmid: 27284331
[15]	Lai G, Mahadevan A, Hackney D, et al. Diagnostic accuracy of PET, SPECT, and arterial spin-labeling in differentiating tumor recurrence from necrosis in cerebral metastasis after stereotactic radiosurgery[J]. AJNR Am J Neuroradiol, 2015,36(12):2250-2255. DOI: 10.3174/ajnr.A4475. doi: 10.3174/ajnr.A4475 pmid: 26427832
[16]	Ma H, Wang Z, Xu K, et al. Three-dimensional arterial spin labeling imaging and dynamic susceptibility contrast perfusion-weighted imaging value in diagnosing glioma grade prior to surgery[J]. Exp Ther Med, 2017,13(6):2691-2698. DOI: 10.3892/etm.2017.4370. doi: 10.3892/etm.2017.4370 pmid: 28587332
[17]	Sundgren PC, Nagesh V, Elias A, et al. Metabolic alterations: a biomarker for radiation-induced normal brain injury—an MR spectroscopy study[J]. J Magn Reson Imaging, 2009,29(2):291-297. DOI: 10.1002/jmri.21657. pmid: 19161192
[18]	Smith EA, Carlos RC, Junck LR, et al. Developing a clinical decision model: MR spectroscopy to differentiate between recurrent tumor and radiation change in patients with new contrast-enhancing lesions[J]. AJR Am J Roentgenol, 2009,192(2):W45-W52. DOI: 10.2214/AJR.07.3934. doi: 10.2214/AJR.07.3934 pmid: 19155380
[19]	Wang HZ, Qiu SJ, Lv XF, et al. Diffusion tensor imaging and¹H-MRS study on radiation-induced brain injury after nasopharyngeal carcinoma radiotherapy [J]. Clin Radiol, 2012,67(4):340-345. DOI: 10.1016/j.crad.2011.09.008. doi: 10.1016/j.crad.2011.09.008
[20]	李国华, 李俊晨, 胡春洪. 鼻咽癌放疗后¹H-MRS早期变化及其与神经认知功能改变的相关性分析 [J]. 临床放射学杂志, 2018,37(11):1804-1808. DOI: 10.13437/j.cnki.jcr.2018.11.010.
[21]	Chen WS, Li JJ, Hong L, et al. Diagnostic value of magnetic resonance spectroscopy in radiation encephalopathy induced by radiothe-rapy for patients with nasopharyngeal carcinoma: a Meta-analysis[J]. Biomed Res Int, 2016,2016:5126074. DOI: 10.1155/2016/5126074. doi: 10.1155/2016/5126074 pmid: 26953103
[22]	Chen W, Qiu S, Li J, et al. Diffusion tensor imaging study on radiation-induced brain injury in nasopharyngeal carcinoma during and after radiotherapy[J]. Tumori, 2015,101(5):487-490. DOI: 10.5301/tj.5000348. doi: 10.5301/tj.5000348 pmid: 25983086
[23]	黎成, 卜超, 黄穗乔. 放射性脑病的影像学诊断进展[J]. 岭南现代临床外科, 2019,19(1):11-18. DOI: 10.3969/j.issn.1009-976x.2019.01.003.
[24]	Leng X, Fang P, Lin H, et al. Structural MRI research in patients with nasopharyngeal carcinoma following radiotherapy: a DTI and VBM study[J]. Oncol Lett, 2017,14(5):6091-6096. DOI: 10.3892/ol.2017.6968. doi: 10.3892/ol.2017.6968 pmid: 29113251
[25]	Duan F, Cheng J, Jiang J, et al. Whole-brain changes in white matter microstructure after radiotherapy for nasopharyngeal carcinoma: a diffusion tensor imaging study[J]. Eur Arch Otorhinolaryngol, 2016,273(12):4453-4459. DOI: 10.1007/s00405-016-4127-x. doi: 10.1007/s00405-016-4127-x pmid: 27272052
[26]	Alfotih GT, Zheng MG, Cai WQ, et al. Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients[J]. Neurol Neurochir Pol, 2016,50(3):172-179. DOI: 10.1016/j.pjnns.2016.02.007. doi: 10.1016/j.pjnns.2016.02.007 pmid: 27154443
[27]	Tsui EY, Chan JH, Ramsey RG, et al. Late temporal lobe necrosis in patients with nasopharyngeal carcinoma: evaluation with combined multi-section diffusion weighted and perfusion weighted MR imaging[J]. Eur J Radiol, 2001,39(3):133-138. DOI: 10.1016/s0720-048x(01)00328-x. doi: 10.1016/s0720-048x(01)00328-x pmid: 11566238
[28]	尹华锦, 陈礼刚. 放射性脑病的诊治研究现状[J]. 泸州医学院学报, 2009,32(6):658-661. DOI: 10.3969/j.issn.1000-2669.2009.06.031.
[29]	Rubovitch V, Zilberstein Y, Chapman J, et al. Restoring GM1 ganglioside expression ameliorates axonal outgrowth inhibition and cognitive impairments induced by blast traumatic brain injury[J]. Sci Rep, 2017,7:41269. DOI: 10.1038/srep41269. doi: 10.1038/srep41269 pmid: 28112258
[30]	唐亚梅, 李艺, 邢诒刚, 等. 神经节苷酯治疗放射后脑损伤的临床研究[J]. 中国神经精神疾病杂志, 2004,30(4):285-286. DOI: 10.3969/j.issn.1002-0152.2004.04.014.
[31]	周开甲, 张鸣, 刘伯伟. 申捷对早期放射性脑损伤的防治研究[J]. 实用癌症杂志, 2014,29(3):343-345. DOI: 10.3969/j.issn.1001-5930.2014.03.033.
[32]	单若莹. 奥拉西坦联合长春西汀对脑梗死患者轻度认知功能障碍的作用[J]. 中国实用神经疾病杂志, 2015,18(11):77. DOI: 10.3969/j.issn.1673-5110.2015.11.050.
[33]	王安峰, 郭燕, 刘明, 等. 奥拉西坦对放疗前后脑照射野内N-乙酰天门冬氨酸、肌酸及胆碱含量的影响[J]. 脑与神经疾病杂志, 2012,20(4):249-251. DOI: 10.3969/j.issn.1006-351X.2012.04.003.
[34]	王安峰, 周洪波, 翟福山, 等. 不同给药时间对奥拉西坦在防治放射性脑损伤中的影响[J]. 河北医药, 2013,35(7):1065-1066. DOI: 10.3969/j.issn.1002-7389.2013.07.061.
[35]	Wang X, Ying H, Zhou Z, et al. Successful treatment of radiation-induced temporal lobe necrosis with mouse nerve growth factor[J]. J Clin Oncol, 2011,29(7):e166-e168. DOI: 10.1200/JCO.2010.31.7081. doi: 10.1200/JCO.2010.31.7081 pmid: 21149661
[36]	何国永, 黄海威, 邓哲治, 等. 鼠神经生长因子对全脑照射大鼠空间认知功能的修复作用[J]. 中华医学杂志, 2016,96(19):1530-1534. DOI: 10.3760/cma.j.issn.0376-2491.2016.19.015.
[37]	Tang Y, Rong X, Hu W, et al. Effect of edaravone on radiation-induced brain necrosis in patients with nasopharyngeal carcinoma after radiotherapy: a randomized controlled trial[J]. J Neurooncol, 2014,120(2):441-447. DOI: 10.1007/s11060-014-1573-4. doi: 10.1007/s11060-014-1573-4 pmid: 25142813
[38]	钟琼. 依达拉奉治疗鼻咽癌放疗后脑损伤疗效对血清IL-6、TNF-α的影响[J]. 医学理论与实践, 2018,31(2):231-232. DOI: 10.19381/j.issn.1001-7585.2018.02.038.