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Updated: Jul 8, 2026
Quantifying Cognitive Decrements Caused by Cranial Radiotherapy
Published on: October 18, 2011
Association of Baseline Glymphatic-Related MRI Metrics With Neoadjuvant Chemotherapy-Related Cognitive Impairment in
Tian-Ye Lin1, Yizhe Hu2, Shao-Shuai Sun1
1Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China.
Background:
Chemotherapy-related cognitive impairment (CRCI) is a common complication for cancer survivors. The glymphatic system is increasingly recognized as playing a role in cognitive health. However, whether the glymphatic system is associated with CRCI and its dynamic change during chemotherapy remains unclear.
Purpose:
To investigate longitudinal changes of glymphatic-related MRI metrics during chemotherapy and their association with CRCI.
Study Type:
Prospective longitudinal.
Population:
Sixty two female patients with breast cancer underwent brain MRI and neuropsychological assessments at baseline and after chemotherapy.
Field Strength/Sequence:
Resting-state functional MRI, diffusion tensor imaging (DTI), 3D T1-weighted magnetization-prepared rapid gradient echo sequence at 3 T.
Assessment:
Patients were divided into cognitive decline (n = 22) and cognitive remain (n = 40) groups according to the Montreal Cognitive Assessment (MoCA) and the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale. MR metrics, including blood-oxygen-level-dependent cerebrospinal coupling (BOLD-CSF coupling), DTI along the perivascular space (DTI-ALPS) index, fraction of perivascular space (PVS/ICV), and choroid plexus volume to intracranial volume (ChP/ICV), were used to reflect glymphatic function.
Statistical Tests:
Linear mixed-effects models were utilized to assess longitudinal trajectories. Analysis of covariance was used to identify differences in glymphatic-related MRI metrics between groups. Multivariable linear regression was used to determine the association between post-chemotherapy cognitive decline and baseline metrics. Significance was defined as p < 0.05 or FDR corrected p < 0.05.
Result:
After chemotherapy, significant cognitive decline, an increase in PVS/ICV, ChP/ICV, and BOLD-CSF coupling strength were observed. Longitudinal changes in MRI metrics did not differ between the cognitive remain and cognitive decline groups (FDR-corrected p = 0.234-0.833). The cognitive decline group had significantly weaker baseline BOLD-CSF coupling strength and larger baseline PVS/ICV compared to the cognitive remain group. Multivariable linear regression revealed that baseline BOLD-CSF coupling strength and PVS/ICV were independent predictors for post-chemotherapy MoCA and FACT-cog scores.
Data Conclusion:
Weaker baseline BOLD-CSF coupling strength and larger PVS volume fraction are associated with CRCI. Longitudinal changes of glymphatic-related MRI metrics may not be associated with CRCI.
Evidence Level:
2.
Technical Efficacy:
Stage 5.
