| Objective:In this study,voxel-based analysis of diffusion kurtosis imaging was used to analyze changes of whole-brain microstructure,and to investigate its changes and correlation with cognitive function impairment in breast cancer survivors with chemotherapy,and to provide early diagnosis for chemotherapy-related cognitive impairment and clinical intervention treatment of chemotherapy related cognitive disorder.Materials and Methods:A total of twenty-three breast cancer patients(Stage Ⅰ～Ⅲ),confirmed by pathology from September 2019 to October 2020 in the Department of Breast surgery of the second people’s Hospital of Changzhou,was collected as the chemotherapy group.Twenty-six healthy volunteers matched with age,years of education were recruited as normal control group.the general clinical data of the two groups were acquired and analyzed statistically after entering the group,the subjects were tested with four neuropsychological cognitive scales: Montreal Cognitive Assessment scale(Mo CA),Trail Making Test A(TMT-A),Auditory Verbal Learning delay Test(AVLT)and Clock Drawing Test(CDT)at the same time.Brain routine MRI sequence and diffusion kurtosis imaging sequence scanning and data acquisition were performed prospectively by using GE Discovery 750 W 3.0T magnetic resonance machine.The first neuropsychological cognitive assessments and MRI sequence scan(T1)of chemotherapy group were performed before the start of chemotherapy.second neuropsychological cognitive assessments and MRI sequence scan(T2)were acquired within two weeks in breast cancer patients after eight cycles of chemotherapy.The control group was performed simultaneously at the beginning of the first MRI sequence scan(T1).The average Radial kurtosis,axial kurtosis,Mean kurtosis parameter diagrams were obtained by DKE software.The neuropsychological cognitive function scale and DKI parameters(MK,RK,AK value)of the two groups were analyzed by SPSS 25.0 software.The paired t test in the chemotherapy group and the independent sample t test of the two groups were used to analyzed the result of neuropsychological test and DKI parameter values.DKI parameter values were calculated by voxel analysis and analyzed statistically by SPM12 software package before and after chemotherapy.The Pearson correlation analysis was performed between DKI parameter values of the brain regions with statistically significant difference and the neuropsychological assessment scores with significant difference after chemotherapy(T2).Results:1.There were no statistically significant differences in neuropsychological test scores and DKI parameters(MK,RK,AK value)between the chemotherapy group before chemotherapy(T1)and the control group(P>0.05).2.There were statistically significant differences in Mo CA,AVLT2,CDT scores and MK and RK value before and after chemotherapy(P<0.05).3.MK value in the genu of corpus callosum,the right posterior cingulate gyrus and the right superior frontal gyrus decreased significantly;RK value in the splenium of corpus callosum,the right middle frontal gyrus decreased significantly after chemotherapy by FDR(P<0.05).Correlation analysis shows that MK value of the right posterior cingulate gyrus was positively correlated with AVLT2 results(r=0.548,P=0.007);RK value of the splenium of corpus callosum was positively correlated with Mo CA results(r=0.654,P=0.001)after chemotherapy.Conclusion:1.In the short time,breast cancer patients receiving chemotherapy have dominant region of brain dysfunction,accompanied by impairment of cognitive domain function,suggesting that cognitive impairment in these regions may be related to the change of brain microstructure integrity.2.Diffusion kurtosis imaging based on VBA can detect brain microstructure change sensitively in breast cancer patients with chemotherapy.MK and RK value of diffusion kurtosis imaging characteristic parameters can reflect changes of brain microstructure.It has a certain reference value in the early evaluation and diagnosis of chemotherapyrelated cognitive impairment. |
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