What question did this study set out to answer?

To investigate the effects of radiotherapy on glymphatic function in nasopharyngeal carcinoma patients through imaging techniques.

May 8, 2026Open Access

Altered glymphatic function in nasopharyngeal carcinoma following radiotherapy: novel insights from choroid plexus volume and free-water fraction analyses

Puntos clave

To investigate the effects of radiotherapy on glymphatic function in nasopharyngeal carcinoma patients through imaging techniques.
Cross-sectional cohort of 101 NPC patients (45 pre-RT, 56 post-RT)
Utilized 3 T MRI, including T1-weighted and diffusion tensor imaging
Performed automated CP segmentation and FWF analysis with Spearman correlation models.
Post-RT patients showed significant CP enlargement and increased FWF in multiple white matter tracts (all p < 0.05).
Maximum doses to brainstem and left temporal lobe correlated strongly with CP volume and WM FWF (all p < 0.05).
CP volume positively correlated with FWF in the PCT and CST, after adjusting for factors like age and gender (all p < 0.05).

Resumen

Background and purpose Radiotherapy (RT) often causes delayed radiation-induced brain injury (RBI) with unclear pathophysiology; emerging evidence links this to glymphatic dysfunction, but radiation effects on cerebrospinal fluid (CSF) dynamics and interstitial fluid-CSF exchange are unstudied. Thus, we used choroid plexus (CP) volume and free-water fraction (FWF) imaging to assess glymphatic changes in Nasopharyngeal carcinoma (NPC) patients after RT. Materials and methods In this cross-sectional cohort of 101 NPC patients (45 pre-RT and 56 post-RT) underwent 3 T MRI, including T1-weighted and diffusion tensor imaging. Automated CP segmentation and tract-specific FWF analysis are performed. Spearman correlation models assessed radiation-dose relationships with CP volume and Whiter matter (WM) FWF. Results We observed that post-RT patients exhibited significant bilateral CP enlargement (total CP: 2560. 56 ± 636. 72 mm 3, left: 1196. 92 ± 334. 53 mm 3, right: 1363. 64 ± 365. 84 mm 3 ; all p 0. 05) and elevated FWF in critical WM tracts, including the pontine crossing tract (PCT), bilateral corticospinal tracts (CST), middle cerebellar peduncle, right inferior cerebellar peduncle, and left medial lemniscus. Radiational dose exhibit strong dose-dependent correlations with CP volume and WM FWF. Maximum doses to the brainstem (MDRTBS) and left temporal lobe (MDRTLT) showed the strongest associations: MDRTLT correlated with left CP volume (r = 0. 599, p 0. 001), right CP volume (r = 0. 585, p 0. 001), and bilateral CST FWF (left: r = 0. 414, p = 0. 005; right: r = 0. 354, p = 0. 017). CP volume positively correlated with FWF in the PCT and CST (left CST vs. total CP: r = 0. 374, p = 0. 011). These associations remained significant after adjusting for age, gender, and intracranial volume (r = 0. 31–0. 58, all p 0. 05). Conclusion The observed association between choroid plexus enlargement and elevated white matter free-water fraction suggests RT-associated glymphatic dysfunction in NPC, offers a novel perspective on the pathogenesis of RBI.

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