title: Serial diffusion tensor imaging to characterize radiation-induced changes in normal-appearing white matter following radiotherapy in patients with adult low-grade gliomas.
abstract: OBJECTIVE
  The aim of this study was to ascertain whether diffusion tensor imaging (DTI) metrics fractional anisotropy (FA), mean diffusivity (MD), linear case (CL), planar case (CP), spherical case (CS)-can characterize a threshold dose and temporal evolution of changes in normal-appearing white matter (NAWM) of adults with low-grade gliomas (LGGs) treated with radiation therapy (RT).
  
  
  METHODS
  Conventional and DTI imaging were performed before RT in 5 patients and subsequently, on average, at 3 months (n = 5), 8 months (n = 3), and 14 months (n = 5) following RT for a total of 18 examinations. Isodose distribution at 5-Gy intervals were visualized in all the slices of fluid attenuated inversion recovery (FLAIR) and the corresponding DTI images without diffusion sensitization (b0DTI). The latter were exported for relative quantitative analysis.
  
  
  RESULTS
  Compared to pre-RT values, FA and CL decreased, whereas CS increased at 3 and 8 months and recovered partially at 14 months for the dose bins >55 Gy and 50-55 Gy. For the 45 50 Gy bin, the FA and CL decreased with an increase in CS at 3 months; no further change was seen at 8 or 14 months. For the >55 Gy and 50-55 Gy bins, CP decreased and MD increased at 3 months and returned to baseline at 8 months following RT.
  
  
  CONCLUSIONS
  Radiation-induced changes in NAWM can be detected at 3 months after RT, with changes in FA, CL, and CS (but not CP or MD) values seen at a threshold dose of 45-50 Gy. A partial recovery was evident by 14 months to regions that received doses of 50-55 Gy and >55 Gy, thus providing an objective measure of radiation effect on NAWM.
authors.affiliation: Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Haris
authors.forename: Shaleen
authors.initials: S
authors.lastname: Kumar
authors.forename: Mani Karthick
authors.initials: MK
authors.lastname: Raj
authors.forename: Koilpillai Joseph Maria
authors.initials: KJ
authors.lastname: Das
authors.forename: Shantanu
authors.initials: S
authors.lastname: Sapru
authors.forename: Sanjay
authors.initials: S
authors.lastname: Behari
authors.forename: Ram Kishore Singh
authors.initials: RK
authors.lastname: Rathore
authors.forename: Ponnada A
authors.initials: PA
authors.lastname: Narayana
authors.forename: Rakesh Kumar
authors.initials: RK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016880:Anisotropy; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D038524:Diffusion Magnetic Resonance Imaging; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000528:radiation effects*; D011832:Radiation Injuries / Q000175:diagnosis*; D011879:Radiotherapy Dosage