Evaluation of radiation induced brain injury in nasopharyngeal carcinoma patients based on multi-parameter quantitative MRI: A prospective longitudinal study

•3D-pCASL + IVIM can help to elucidate the mechanism of RT induced brain injury of NPC patients.•Cluster analyses complemented the mainstream trends in the variation of MR parameters.•Damage of microvessels and brain cells may vary at different times post-RT. Three dimensional pulsed continuous arte...

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Published in:Radiotherapy and oncology 2025-01, Vol.202, p.110621, Article 110621
Main Authors: Huang, Lin-Wen, Pan, Jia-Wei, Li, Bo, Wu, Wen-xiu, Guo, Li, Zhou, Xin-han, Zhang, Xianhai, Gao, Ming-yong, Xu, Zhi-feng
Format: Article
Language:English
Subjects:
Arterial spin labeling
Intravoxel incoherent motion
Nasopharyngeal carcinoma
Radiotherapy
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Summary:•3D-pCASL + IVIM can help to elucidate the mechanism of RT induced brain injury of NPC patients.•Cluster analyses complemented the mainstream trends in the variation of MR parameters.•Damage of microvessels and brain cells may vary at different times post-RT. Three dimensional pulsed continuous arterial spin labeling (3D-pCASL) and incoherent movement within voxels (IVIM) imaging was combined to assess dynamic microscopic structure changes of the hippocampus and temporal lobe white matter (TLWM) of nasopharyngeal carcinoma (NPC) patients post intensity-modulated radiation therapy (IMRT). Forty-six patients who were first diagnosed with NPC and underwent IMRT were prospectively enrolled. 3D-CASL and IVIM were performed pre-RT, within 1 week (1 W) post-RT, 3 months (3 M) post-RT, 6 months (6 M) post-RT, and 18 months (18 M) post-RT. Twenty-seven patients completed follow-ups for all time periods, and their data were analyzed. The cerebral flow (CBF) derived from ASL, and apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (F) derived from IVIM of hippocampus and TLWM were analyzed. The quantitative parameters were measured before RT as the baseline, and the corresponding parameter values and change rates at each time point post-RT were compared using the non-parametric Wilcoxon rank sum test. At 1 W post-RT, CBF showed a significant increase and peaked in both the hippocampus and TLWM (p 
ISSN:0167-8140
1879-0887
1879-0887
DOI:10.1016/j.radonc.2024.110621