Abstract
Purpose
The aim of this study was to ascertain whether diffusion tensor imaging (DTI) metrics—fractional anisotropy (FA), mean diffusivity (MD), linear case (CL), planar case (CP), spherical case (CS)—can characterize a threshold dose and temporal evolution of changes in normal-appearing white matter (NAWM) of adults with low-grade gliomas (LGGs) treated with radiation therapy (RT).
Methods and materials
Conventional and DTI imaging were performed before RT in 5 patients and subsequently, on average, at 3 months (n = 5), 8 months (n = 3), and 14 months (n = 5) following RT for a total of 18 examinations. Isodose distribution at 5-Gy intervals were visualized in all the slices of fluid attenuated inversion recovery (FLAIR) and the corresponding DTI images without diffusion sensitization (b0DTI). The latter were exported for relative quantitative analysis.
Results
Compared to pre-RT values, FA and CL decreased, whereas CS increased at 3 and 8 months and recovered partially at 14 months for the dose bins > 55 Gy and 50–55 Gy. For the 45–50 Gy bin, the FA and CL decreased with an increase in CS at 3 months; no further change was seen at 8 or 14 months. For the >55 Gy and 50–55 Gy bins, CP decreased and MD increased at 3 months and returned to baseline at 8 months following RT.
Conclusion
Radiation-induced changes in NAWM can be detected at 3 months after RT, with changes in FA, CL, and CS (but not CP or MD) values seen at a thresh-old dose of 45–50 Gy. A partial recovery was evident by 14 months to regions that received doses of 50–55 Gy and >55 Gy, thus providing an objective measure of radiation effect on NAWM.
Similar content being viewed by others
References
Schultheiss TE, Kun LE, Ang KK, Stephens LC. Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 1995;31:1093–1112.
Fike JR, Gobbel GT. Central nervous system radiation injury in large animal models. In: Gutin PH, Leibel SA, Sheline GE, editors. Radiation injury to the nervous system. New York: Raven; 1991. p. 113–135.
Zeman W, Samorajski T. Effects of irradiation on the nervous system. In: de Berdjis CC, editor. Pathology of irradiation. Baltimore: Williams & Wilkins; 1971. p. 213–277.
Bailey OT. Basic problems in the histopathology of radiation of the central nervous system. In: Haley TJ, Snider RS, editors. Response of the nervous system to ionizing radiation. San Diego: Academic; 1962. p. 536–547.
Martins AN, Johnston JS, Henry JM, Stoffel TJ, Di Chiro G. Delayed necrosis of the brain. J Neurosurg 1977;47:336–345.
Dooms GC, Hecht S, Brant-Zawadzki M, Berthiaume Y, Norman D, Newton TH. Brain radiation lesions: MR imaging. Radiology 1986;158:149–155.
Constine LS, Konski A, Ekholm S, McDonald S, Rubin P. Adverse effects of brain irradiation correlated with MR and CT imaging. Int J Radiat Oncol Biol Phys 1988;15:319–330.
Corn BW, Yousem DM, Scott CB, Rotman M, Asbell SO, Nelson DF, et al. White matter changes are correlated significantly with radiation dose. Cancer 1994;74:2828–2835.
Jansen EP, Dewit LG, van Herk M, Bartelink H. Target volumes in radiotherapy for high-grade malignant glioma of the brain. Radiother Oncol 2000;56:151–156.
Pu AT, Sandler HM, Radany EH, Blavias M, Page MA, Greenberg HS, et al. Low grade gliomas: preliminary analysis of failure patterns among patients treated using 3D conformal external beam irradiation. Int J Radiat Oncol Biol Phys 1995;31:461–466.
Curnes JT, Laster DW, Ball MR, Moody DM, Witcofski RL. MR of radiation injury to the brain. AJR Am J Roentgenol 1986;147:119–124.
Gupta RK, Saksena S, Hasan KM, Agarwal A, Haris M, Pandey CM, et al. Focal Wallerian degeneration of the corpus callosum in large middle cerebral artery stroke: serial diffusion tensor imaging. J Magn Reson Imaging 2006;24:549–555.
Gupta RK, Saksena S, Agarwal A, Hasan KM, Husain M, Gupta V, et al. Diffusion tensor imaging in late posttraumatic epilepsy. Epilepsia 2005;46:1465–1471.
Trivedi R, Gupta RK, Agarawal A, Hasan KM, Gupta A, Prasad KN, et al. Assessment of white matter damage in subacute sclerosing panencephalitis using quantitative diffusion tensor MRI. Am J Neuroradiol 2006;27:1712–1716.
Le Bihan D, Mangin JF, Poupon C, Clark CA, Pappata S, Molko N, et al. Diffusion tensor imaging: concepts and applications. J Magn Reson Imaging 2001;13:534–546.
Le Bihan D. Looking into the functional architecture of the brain with diffusion MRI. Nat Rev Neurosci 2003;6:469–480.
Khong PL, Kwong DL, Chan GC, Sham JS, Chan FL, Ooi GC. Diffusion-tensor imaging for the detection and quantification of treatment-induced white matter injury in children with medulloblastoma: a pilot study. Am J Neuroradiol 2003;24:734–740.
Kitahara S, Nakasu S, Murata K, Sho K, Ito R. Evaluation of treatment-induced cerebral white matter injury by using diffusion-tensor MR imaging: initial experience. Am J Neuroradiol 2005;26:2200–2206.
Qiu D, Kwong DL, Chan GC, Leung LH, Khong PL. Diffusion tensor magnetic resonance imaging finding of discrepant fractional anisotropy between the frontal and parietal lobes after whole-brain irradiation in childhood medulloblastoma survivors: reflection of regional white matter radiosensitivity? Int J Radiat Oncol Biol Phys 2007;69:846–851.
Qiu D, Leung LH, Kwong DL, Chan GC, Khong PL. Mapping radiation dose distribution on the fractional anisotropy map: applications in the assessment of treatment-induced white matter injury. Neuroimage 2006;31:109–115.
Westin CF, Peled S, Gubjartsson H, Kikinis R, Jolesz FA. Geometrical diffusion measures for MRI from tensor basis analysis. Vancouver, Canada: International Society of Magnetic Resonance in Medicine; 1997. p. 1742.
Peled S, Gudbjartsson H, Westin CF, Kikinis R, Jolesz FA. Magnetic resonance imaging shows orientation and asymmetry of white matter fiber tracts. Brain Res 1998;780:27–33.
Alexander AL, Hasan K, Kindlmann G, Parker DL, Tsuruda JS. A geometric analysis of diffusion tensor measurements of the human brain. Magn Reson Med 2000;44:283–291.
Baser PJ. Inferring microstructural features and the physiological state of tissues from diffusion-weighted images. NMR Biomed 1995;8:333–344.
Hasan KM, Parker DL, Alexander AL. Comparison of gradient encoding schemes for diffusion-tensor MRI. J Magn Reson Imaging 2001;13:769–780.
Hasan KM, Narayana PA. Computation of the fractional anisotropy and mean diffusivity maps without tensor decoding and diagonalization: theoretical analysis and validation. Magn Reson Med 2003;50:589–598.
Woods RP, Mazziotta JC, Cherry SR. MRI-PET registration with automated algorithm. J Comput Assist Tomogr 1993;17:536–546.
Purwar A, Gupta RK, Sarma MK, Bayu G, Singh A, Rathore DK, et al. De-scalping of the brain in echo planar DT-MRI. Presented at the 14th International Society of Magnetic Resonance in Medicine, Seattle, 2006, abstract 1607.
Hasan KM, Basar PJ, Parkar DL, Alexander AL. Analytical computation of the eigen values and eigenvectors in DT-MRI. J Magn Reson 2001;152:41–47.
Purwar A, Rathore DK, Rathore RKS, Gupta RK. A DT-MRI analysis tool. Presented at the European Society of Magnetic Resonance in Medicine and Biology, Warsaw, Poland, 2006, abstract 644.
Jalali R, Goswami S, Sarin R, More N, Siddha M, Kamble R. Neuropsychological status in children and young adults with benign and low-grade brain tumors treated prospectively with focal stereotactic conformal radiotherapy. Int J Radiat Oncol Biol Phys 2006;66:S14–S19.
Roman DD, Sperduto PW. Neuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys 1995;31:983–998.
Gregor A, Cull A, Traynor E, Stewart M, Lander F, Love S. Neuropsychometric evaluation of long-term survivors of adult brain tumours: relationship with tumour and treatment parameters. Radiother Oncol 1996;41:55–59.
Crossen JR, Garwood D, Glatstein E, Neuwelt EA. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation induced encephalopathy. J Clin Oncol 1994;12:627–642.
Steen RG, Koury BSM, Granja CI, Xiong X, Wu S, Glass JO, et al. Effect of ionizing radiation on the human brain: white matter and gray matter T1 in pediatric brain tumor patients treated with conformal radiotherapy. Int J Radiat Oncol Biol Phys 2001;49:79–91.
Van der Kogel AJ. Central nervous system radiation injury in small animal models. In: Gutin PH, Leibel SA, Sheline GE, editors. Radiation injury to the nervous system. New York: Raven; 1991 p. 91–111.
Delattre JY, Rosenblum MK, Thaler HT, Mandell L, Shapiro WR, Posner JB. A model of radiation myelopathy in the rat: pathology, regional capillary permeability changes and treatment with dexamethasone. Brain 1988;111:1319–1336.
Caveness WF, Tanaka A, Hess KH, Kemper TL, Tso MO, Zimmerman LE. Delayed brain swelling and functional dear-rangement after X-irradiation of the right visual cortex in the Macaca mulatta. Radiat Res 1974;57:104–120.
Filippi M, Cercignani M, Inglese M, Horsfield MA, Comi G. Diffusion tensor magnetic resonance imaging in multiple sclerosis. Neurology 2001;56:304–311.
Beaulieu C. The basis of anisotropic water diffusion in the nervous system: a technical review. NMR Biomed 2002;15:435–455.
Caveness WF, Carsten AL, Roizin L. Pathogenesis of X-irradiation effects in the monkey cerebral cortex. Brain Res 1968;7:1–117.
Groothius DR, Wright DC, Ostertag CB. The effect of 125I interstitial radiotherapy on blood brain barrier function in normal canine brain. J Neurosurg 1987;67:895–902.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Haris, M., Kumar, S., Raj, M.K. et al. Serial diffusion tensor imaging to characterize radiation-induced changes in normal-appearing white matter following radiotherapy in patients with adult low-grade gliomas. Radiat Med 26, 140–150 (2008). https://doi.org/10.1007/s11604-007-0209-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-007-0209-4