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Quantifying Radiation Therapy–induced Brain Injury with Whole-Brain Proton MR Spectroscopy: Initial Observations¹

¹ From the Departments of Radiation Oncology (B.M., B.S.Y.L., B.L.F., N.N., O.G.) and Biostatistics (J.S.B.), Fox Chase Cancer Center, 7701 Burholme Ave, Philadelphia, PA 19111. From the 2000 RSNA scientific assembly. Received October 11, 2000; revision requested November 26; revision received February 28, 2001; accepted April 9. Supported by National Institutes of Health grants RO1 NS33385, NS37739, and NS29029. Address correspondence to B.M. (e-mail: b_movsas@fccc.edu).

PURPOSE: To quantify the extent of neuronal cell loss imparted to the brain by means of radiation therapy through the decline of the amino acid derivative N-acetylaspartate (NAA) by using proton (hydrogen 1) magnetic resonance (MR) spectroscopy.

MATERIALS AND METHODS: Proton MR spectroscopy in a clinical MR imager was used to ascertain the amount of whole-brain NAA before and immediately after whole-brain radiation therapy 3–4 weeks later. Eight patients (four women, four men; median age, 55 years; age range, 39–70 years) were studied. All subjects had lung cancer (non–small cell lung cancer [n = 5], small-cell lung cancer [n = 3]) and received either palliative or prophylactic whole-brain radiation therapy. Six of them also underwent a Mini-Mental Status Examination (MMSE) for correlation with the whole-brain NAA. Two-tailed Student t tests were used to evaluate the data.

RESULTS: A significant (P = .042) average decline in whole-brain NAA of -0.91 mmol per person was observed in the cohort. No corresponding changes occurred in MMSE scores. There was no significant difference in whole-brain NAA decline between prophylactic and therapeutic whole-brain radiation therapy.

CONCLUSION: Since whole-brain NAA loss was detected even when MMSE scores were unchanged, the former seems to be a more sensitive measure of radiation therapy injury than is the latter.

Index terms: Brain, injuries, 13.47 • Brain, MR, 13.12145 • Magnetic resonance (MR), spectroscopy, 13.12145 • Radiations, injurious effects, complications of therapeutic radiology, 13.47

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