乳腺癌化疗患者脑结构与认知功能改变的扩散峰度成像研究

Diffusion kurtosis imaging study on changes of brain microstructure and cognitive function in breast cancer survivors with chemotherapy

目的应用基于体素分析的扩散峰度成像(diffusion kurtosis imaging,DKI)技术,探讨接受化疗的乳腺癌患者脑微结构的改变及与认知功能损伤的相关性。材料与方法前瞻性纳入经手术病理证实的乳腺癌(Ⅰ~Ⅲ期)患者23例和年龄、受教育程度匹配的健康志愿者26例进行神经心理学测试和DKI数据采集,获得神经心理学评估分数和平均扩散峰度(mean kurtosis,MK)、径向峰度(radial kurtosis,RK)、轴向峰度(axial kurtosis,AK)参数图。采用SPSS 25.0软件对受试者一般临床资料、DKI参数值进行统计学分析,分析化疗后差异有统计学意义脑区的DKI参数值与神经心理学评分的相关性。结果乳腺癌患者化疗前与对照组的神经心理学评分、DKI参数值差异无统计学意义(P<0.05);乳腺癌患者化疗前后蒙特利尔认知评估(Montreal Cognitive Assessment Scale,MoCA)、画钟测试、听觉词语学习延迟5 min测试(Auditory Verbal Learning Delay 5 min Test,AVLT2)评分、MK值、RK值差异有统计学意义(P<0.05);MK值减低的脑区有胼胝体膝部、右侧后扣带回、右侧额上回;RK值减低的脑区有:后扣带回、右侧额中回。化疗后右侧后扣带回MK值与AVLT2结果呈正相关(r=0.548,P=0.007);化疗后后扣带回RK值与MoCA结果呈正相关(r=0.654,P=0.001)。结论接受化疗的乳腺癌患者短期内存在一定的脑损伤优势区域并与认知功能障碍相关。MK、RK值可反映脑细微结构的改变,在化疗相关认知障碍的早期评估中具有一定的参考价值。

Objective:To study changes of brain microstructure and cognitive function after chemotherapy in breast cancer survivors by using voxel-based analysis of diffusion kurtosis imaging(DKI).Materials and Methods:A total of 23 breast cancer patients(StageⅠ-Ⅲ),confirmed by pathology,and 26 age-and gender-matched control healthy volunteers were recruited for prospective Neuropsychological assessments and DKI data acquisition.The statistical product and SPSS 25.0 software was performed to evaluate the difference of subjects’general clinical data and mean kurtosis(MK),axial kurtosis(AK),radial kurtosis(RK)value,the correlation between DKI parameters of different brain regions and neuropsychological assessments scores were analyzed.Results:There were no statistically significant differences in neuropsychological scores and MK,AK,RK value between the chemotherapy group and the control group before chemotherapy.There were statistically significant differences in Montreal Cognitive Assessment Scale(MoCA),Clock Drawing Test,Auditory Verbal Learning Delay 5 min Test(AVLT2)scores and MK,RK value before and after chemotherapy(P<0.05).MK value in the genu of corpus callosum,the right posterior cingulate gyrus and the right superior frontal gyrus decreased significantly;RK value in the posterior cingulate gyrus,the right middle frontal gyrus decreased significantly after chemotherapy by false discovery rate(P<0.05).Correlation analysis shows that MK value of the right posterior cingulate gyrus was positively correlated with AVLT2 results(r=0.548,P=0.007);RK value of the posterior cingulate gyrus was positively correlated with MoCA results(r=0.654,P=0.001)after chemotherapy.Conclusions:In the short term,there are dominant region associated with cognitive impairment in breast cancer survivors with chemotherapy.The MK,RK value can be sensitive to changes of brain microstructure,and provide valuable reference for early evaluation of chemotherapy-related cognitive impairment.