AUTHOR=Zheng Xingyou , Peng Jianchun , Zhao Qing , Li Li , Gao Jian-ming , Zhou Keyang , Tan Bei , Deng Lingling , Zhang Youming 

TITLE=Radiation-induced glymphatic dysfunction in patients with nasopharyngeal carcinoma: a study using diffusion tensor image analysis along the perivascular space

JOURNAL=Frontiers in Neuroscience

VOLUME=17

YEAR=2024

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1321365

DOI=10.3389/fnins.2023.1321365

ISSN=1662-453X

ABSTRACT=<p>Radiation encephalopathy (RE) refers to radiation-induced brain necrosis and is a life-threatening complication in patients with nasopharyngeal carcinoma (NPC) after radiotherapy (RT), and radiation-induced pre-symptomatic glymphatic alterations have not yet been investigated. We used diffusion tensor image analysis along the perivascular space (DTI-ALPS) index to examine the pre-symptomatic glymphatic alterations in NPC patients following RT. A total of 109 patients with NPC consisted of Pre-RT (<italic>n</italic> = 35) and Post-RT (<italic>n</italic> = 74) cohorts were included. The post-RT NPC patients, with normal-appearing brain structure at the time of MRI, were further divided into Post-RT-RE- (<italic>n</italic> = 58) and Post-RT-RE+ (<italic>n</italic> = 16) subgroups based on the detection of RE in follow-up. We observed lower DTI-ALPS <sub>left</sub> index, DTI-ALPS <sub>right</sub> index and DTI-ALPS <sub>whole brain</sub> index in post-RT patients than that in pre-RT patients (<italic>p</italic> &lt; 0.05). We further found that post-RT-RE+ patients demonstrated significantly lower DTI-ALPS <sub>right</sub> (<italic>p</italic> = 0.013), DTI-ALPS <sub>whole brain</sub> (<italic>p</italic> = 0.011) and marginally lower DTI-ALPS <sub>left</sub> (<italic>p</italic> = 0.07) than Post-RT <sub>non-RE</sub> patients. Significant negative correlations were observed between the maximum dosage of radiation-treatment (MDRT) and DTI-ALPS <sub>left</sub> index (<italic>p</italic> = 0.003) as well as DTI-ALPS <sub>whole brain</sub> index (<italic>p</italic> = 0.004). Receiver operating characteristic (ROC) curve analysis showed that DTI-ALPS <sub>whole brain</sub> index exhibited good performance (AUC = 0.706) in identifying patients more likely developing RE. We concluded that glympathic function was impaired in NPC patients following RT and DTI-ALPS index may serve as a novel imaging biomarker for diagnosis of RE.</p>