Quantifying radiation therapy-induced brain injury with whole-brain protonMR spectroscopy: Initial observations

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 deriva tive N-acetylaspartate (NAA) by using proton (hydrogen 1) magnetic resonanc e (MR) spectroscopy. MATERIALS AND METHODS: Proton MR spectroscopy in a clinical MR imager was u sed 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 lun g cancer [n = 3]) and, received either palliative or prophylactic whole-bra in radiation therapy. Six of them also underwent a Mini-Mental Status Exami nation (MMSE) for correlation with th 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 -0.9 1 mmol per person was observed in the cohort. No corresponding changes occu rred 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 w ere unchanged, the former seems to be a more sensitive measure of radiation therapy injury than is the latter.