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Evaluation of Treatment-Induced Cerebral White Matter Injury by Using Diffusion-Tensor MR Imaging: Initial Experience

Sawako Kitaharaa, Satoshi Nakasub, Kiyoshi Murataa, Keizen Shoa and Ryuta Itoa

a Departments of Radiology, Shiga University of Medical Science, Shiga, Japan
b Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan



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  		FIG 1. Schedule of surgery, chemotherapy, radiation therapy, and MR examination.



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  		FIG 2. A 42-year-old male control subject. Three continuous section locations in the supraventricular plane.

A, WM segmented automatically from the reprocessed 3D SPGR T1-weighted images (1.9/9.2/1 [TE/TR/NEX]).

B, Reprocessed axial 3D SPGR images.

C, Isotropic ADC maps.

D, FA maps. Means of isotropic ADC and FA values of the pixels within the segmented WM of each hemisphere are calculated.



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  		FIG 3. A VOI for proton MR spectroscopy is placed within WM in the same supraventricular plane, from which DT MR imaging indices are derived.



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  		FIG 4. Temporal variations of the DT MR imaging and proton MR spectroscopy indices of the patient groups. Error bars represent the SDs of values.

A, NAA/Cr ratio. A reduction of average of NAA/Cr ratios of the patient group 2 is shown (P = .04).

B, Mean isotropic ADC value. An increase in average of mean isotropic ADC values of the patient group 2 is observed (P = .0085).

C, Mean FA value. A decrease in average of mean FA values of the patient group 2 is shown (P = .004).



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  		FIG 5. A 64-year-old man with total removal surgery for metastatic brain tumor, 30-Gy whole brain irradiation, and 15-Gy stereotactic radiosurgery (patient 5). The indices from only the left hemisphere were calculated because the right hemisphere had image distortion caused by the surgical procedure.

A, Axial T2-weighted images (TR/effective/TE/echo train length, 4000 ms/95 ms/18) at 4 (group 2; left), 8 (group 3, middle), and 12 months (group 4, right) following completion of radiation therapy show no abnormal intensity change in WM. At 12 months, slight increase in subarachnoid space of the right hemisphere is shown.

B, Isotropic ADC maps at 4 (left), 8 (middle), and 12 months (right) after completion of radiation therapy. Mean isotropic ADC values were 0.780, 0.707, and 0.720 (x10–3 mm2/s), respectively.

C, FA maps at 4 (left), 8 (middle), and 12 months (right) after completion of radiation therapy. Mean FA values were 0.32, 0.35, and 0.37, respectively. At 4 months after completion of radiation therapy, the mean FA value decreased and mean isotropic ADC value increased in comparison with the averages of mean FA value (0.38; SD = 0.02) and the mean isotropic ADC value (0.692; SD = 0.014) of the controls. The change of the indices appeared to resolve with time.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X