TY - JOUR
T1 - Evaluating Physiological MRI Parameters in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery—A Preliminary Analysis and Case Report
AU - van Grinsven, Eva E.
AU - de Leeuw, Jordi
AU - Siero, Jeroen C. W.
AU - Verhoeff, Joost J. C.
AU - van Zandvoort, Martine J. E.
AU - Cho, Junghun
AU - Philippens, Marielle E. P.
AU - Bhogal, Alex A.
N1 - Funding Information: The APRICOT study described in the current manuscript, as well as the first author (Eva van Grinsven), were supported by research funding from the Dutch Cancer Society “Koningin Wilhelmina Fonds (KWF)” (#11110). Alex Bhogal is supported by a Dutch research council talent grant nowO VENI: The ischemic fingerprint, [VI.VENI.194.056]). The funding sources had no role in conducting this research or preparation of this manuscript. No other declarations of interests apply. Publisher Copyright: © 2023 by the authors.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Brain metastases occur in ten to thirty percent of the adult cancer population. Treatment consists of different (palliative) options, including stereotactic radiosurgery (SRS). Sensitive MRI biomarkers are needed to better understand radiotherapy-related effects on cerebral physiology and the subsequent effects on neurocognitive functioning. In the current study, we used physiological imaging techniques to assess cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO 2) and cerebrovascular reactivity (CVR) before and three months after SRS in nine patients with brain metastases. The results showed improvement in OEF, CBF and CMRO 2 within brain tissue that recovered from edema (all p ≤ 0.04), while CVR remained impacted. We observed a global post-radiotherapy increase in CBF in healthy-appearing brain tissue (p = 0.02). A repeated measures correlation analysis showed larger reductions within regions exposed to higher radiotherapy doses in CBF (r rm = −0.286, p < 0.001), CMRO 2 (r rm = −0.254, p < 0.001), and CVR (r rm = −0.346, p < 0.001), but not in OEF (r rm = −0.004, p = 0.954). Case analyses illustrated the impact of brain metastases progression on the post-radiotherapy changes in both physiological MRI measures and cognitive performance. Our preliminary findings suggest no radiotherapy effects on physiological parameters occurred in healthy-appearing brain tissue within 3-months post-radiotherapy. Nevertheless, as radiotherapy can have late side effects, larger patient samples allowing meaningful grouping of patients and longer follow-ups are needed.
AB - Brain metastases occur in ten to thirty percent of the adult cancer population. Treatment consists of different (palliative) options, including stereotactic radiosurgery (SRS). Sensitive MRI biomarkers are needed to better understand radiotherapy-related effects on cerebral physiology and the subsequent effects on neurocognitive functioning. In the current study, we used physiological imaging techniques to assess cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO 2) and cerebrovascular reactivity (CVR) before and three months after SRS in nine patients with brain metastases. The results showed improvement in OEF, CBF and CMRO 2 within brain tissue that recovered from edema (all p ≤ 0.04), while CVR remained impacted. We observed a global post-radiotherapy increase in CBF in healthy-appearing brain tissue (p = 0.02). A repeated measures correlation analysis showed larger reductions within regions exposed to higher radiotherapy doses in CBF (r rm = −0.286, p < 0.001), CMRO 2 (r rm = −0.254, p < 0.001), and CVR (r rm = −0.346, p < 0.001), but not in OEF (r rm = −0.004, p = 0.954). Case analyses illustrated the impact of brain metastases progression on the post-radiotherapy changes in both physiological MRI measures and cognitive performance. Our preliminary findings suggest no radiotherapy effects on physiological parameters occurred in healthy-appearing brain tissue within 3-months post-radiotherapy. Nevertheless, as radiotherapy can have late side effects, larger patient samples allowing meaningful grouping of patients and longer follow-ups are needed.
KW - brain metastases
KW - cerebral blood flow
KW - cerebral metabolic rate of oxygen
KW - cerebrovascular reactivity
KW - cognition
KW - oxygen extraction fraction
KW - radiotherapy
KW - stereotactic radiosurgery
UR - http://www.scopus.com/inward/record.url?scp=85170260841&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/cancers15174298
DO - https://doi.org/10.3390/cancers15174298
M3 - Article
C2 - 37686575
SN - 2072-6694
VL - 15
JO - Cancers
JF - Cancers
IS - 17
M1 - 4298
ER -