Highlights
- •Evaluation of DWI changes in white matter after proton therapy.
- •Significant diffusion changes were found in high-dose regions.
- •Linear-mixed models unveiled significant dependencies of ADC on dose and time.
- •Perfusion-related parameters presented mixed results.
- •Diffusion restriction may characterize radiation-induced cellular injury.
Abstract
Purpose
To evaluate changes in diffusion and perfusion-related properties of white matter
(WM) induced by proton therapy, which is capable of a greater dose sparing to organs
at risk with respect to conventional X-ray radiotherapy, and to eventually expose
early manifestations of delayed neuro-toxicities.
Methods
Apparent diffusion coefficient (ADC) and IVIM parameters (D, D* and f) were estimated
from diffusion-weighted MRI (DWI) in 46 patients affected by meningioma and treated
with proton therapy. The impact on changes in diffusion and perfusion-related WM properties
of dose and time, as well as the influence of demographic and pre-treatment clinical
information, were investigated through linear mixed-effects models.
Results
Decreasing trends in ADC and D were found for WM regions hit by medium–high (30–40 Gy(RBE))
and high ( Gy(RBE)) doses, which are compatible with diffusion restriction due to radiation-induced
cellular injury. Significant influence of dose and time on median ADC changes were
observed. Also, D* showed a significant dependency on dose, whereas f consistently
showed no dependency on dose and time. Age, gender and surgery extent were also found
to affect changes in ADC.
Conclusions
These results overall agree with those from studies conducted on cohorts of mixed
proton and X-ray radiotherapy patients. Future work should focus on relating our findings
with clinical information of co-morbidities and thus exploiting such or more advanced
imaging data to build normal tissue complication probability models to better integrate
clinical and dose information.
Keywords
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Article info
Publication history
Published online: April 16, 2021
Accepted:
March 23,
2021
Received in revised form:
March 8,
2021
Received:
January 30,
2021
Identification
Copyright
© 2021 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
