방사선의학 웹진

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Abstract
Purpose: To evaluate changes in cerebral interstitial fluid dynamics following whole-brain radiotherapy (WBRT) for brain metastases using the diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index, and to investigate the relationship between these changes and the subsequent development of radiation-induced leukoencephalopathy (LEP).

Materials and methods: A retrospective analysis was conducted on 50 patients who underwent WBRT for brain metastases. Baseline and post-WBRT DTI-ALPS indices were compared using paired t-tests. Univariate and multivariate linear regression analyses were performed to assess the relationship between changes in the DTI-ALPS index and clinical- and treatment-related factors. In a subset of 33 patients, univariate and multivariate logistic regression analyses were conducted to explore the association between the percentage change in the DTI-ALPS index and the development of LEP at 6-month follow-up, after adjustment for relevant clinical- and treatment-related factors.

Results: The mean DTI-ALPS index decreased significantly following WBRT (baseline: 1.487±0.257; post-WBRT: 1.353±0.229; p<0.001). A higher baseline DTI-ALPS index was significantly associated with a greater decline in the index post-WBRT (p=0.023). In the logistic regression analysis, a greater percentage reduction in the DTI-ALPS index was the only factor significantly associated with LEP development at 6 months (p=0.048).

Conclusion: WBRT is associated with impaired cerebral interstitial fluid dynamics, as reflected by a significant reduction in the DTI-ALPS index. A greater decline in the DTI-ALPS index was predictive of LEP development, suggesting its potential utility as a biomarker for early diagnosis of radiation-induced LEP.

Affiliations

Bio Joo 1, Mina Park 1, Sung Jun Ahn 1, Sang Hyun Suh 1, Jina Kim 2, Sun Ho Min 2, Yeona Cho 3
1Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
2Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
3Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. iamyona@yuhs.ac.