DTI观察乳腺癌化疗前后脑白质微结构与认知功能变化  

DTI observation on changes of brain white matter microstructure and cognitive function in breast cancer patients undergoing chemotherapy

作　　者：刘伟[1] 宋晨[2] 陈宏海[1] 于传文[1] 翟方兵[1] 王磊[1] 孙闯[1] 伍建林[3] LIU Wei;SONG Chen;CHEN Honghai;YU Chuanwen;ZHAI Fangbing;WANG Lei;SUN Chuang;WU Jianlin(Department of Radiology,the Second Hospital of DalianMedical University,Dalian 116027,China;Department of Oncology,the Second Hospital of DalianMedical University,Dalian 116027,China;Department of Radiology,AffiliatedZhongshan Hospital of Dalian University,Dalian 116001,China)

机构地区：[1]大连医科大学附属第二医院放射科,辽宁大连116027 [2]大连医科大学附属第二医院肿瘤科,辽宁大连116027 [3]大连大学附属中山医院放射科,辽宁大连116001

出　　处：《中国医学影像技术》2019年第4期516-520,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨化疗前后乳腺癌患者脑白质微结构和认知功能变化及其相关性。方法收集经手术病理证实的21例早期乳腺癌患者,于化疗前和化疗结束后1个月进行神经心理认知测试和全脑DTI,比较化疗前后全脑整体及脑白质区域各向异性分数(FA)和平均弥散率(MD)的差异,并与神经心理认知测试结果进行相关性分析。结果化疗前后乳腺癌患者Stroop字测试和干扰测试、数字广度倒背测试、数字符号测试、听觉词语学习延迟5 min测试差异有统计学意义(P均<0.05)。化疗前后乳腺癌患者全脑白质整体FA、MD值差异无统计学意义(P均>0.05);化疗后右侧丘脑后辐射、右侧矢状层、右侧上纵束FA值较化疗前降低(P均<0.05),右侧内囊豆状核后部、右侧丘脑后辐射、右侧矢状层、双侧扣带束、双侧下额枕束MD值较化疗前升高(P均<0.05);左侧扣带束MD值与Stroop干扰测试结果呈正相关(r=0.457,P=0.037)。结论乳腺癌患者化疗后局部白质完整性下降,可能是某一认知领域功能减退的神经解剖学基础。Objective To explore the changes of brain white matter microstructure and cognitive impairment after chemotherapy and their correlation in breast cancer patients. Methods Totally 21 breast cancer patients confirmed by pathology were enrolled.All patients underwent DTI and neuropsychological assessment before and 1 month after chemotherapy.The fractional anisotropy (FA) and mean diffusivity(MD) values of the global and regional brain white matters were compared before and after chemotherapy,and the correlation with neuropsychological test results was analyzed. Results The differences of Stroop word test,Stroop interference test,auditory verbal learning test 5 min delayed scores and the digital span backward test scores were statistically significant before and after chemotherapy (all P <0.05).FA and MD values of global white matter had no significant difference before and after chemotherapy (both P >0.05).FA values in right posterior thalamic radiation,right sagittal stratum and right superior longitudinal fasciculus decreased significantly after chemotherapy (all P <0.05),while MD values in 7 white matter areas increased (all P <0.05),including right retrolenticular part of internal capsule,right posterior thalamic radiation,right sagittal stratum,bilateral cingulum and bilateral inferior fronto-occipital fasciculus.MD of left cingulum had positive correlation with Stroop interference test ( r =0.457, P =0.037). Conclusion Decrease of the integrity of regional brain white matter in breast cancer patients after chemotherapy may provide the neuroanatomical basis for the decline of some cognitive functions.

关 键 词：乳腺肿瘤 药物疗法 认知功能障碍 扩散张量成像 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]