Evaluation of the potential of diffusion tensor imaging biomarkers in prediction of white matter changes after brain radiation therapy: A systematic review

Abstract

Background: The objective of this study was to systematically review the use of diffusion tensor imaging (DTI) biomarkers in the early detection of radiation-induced white matter (WM) changes. Materials and Methods: The PubMed and Scopus databases were searched for peer-reviewed articles published in English up to November 28, 2022, according to the PRISMA guidelines to identify studies that related to changes in DTI parameters after radiotherapy. Results: After reviewing the literature, eight studies met the inclusion criteria. The results indicated that changes in the late delay phase were completely related to changes in the acute phase. There was a difference in the sensitivity of the biomarkers between studies. Still, there was substantial evidence for the early detection of changes by axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA). However, further research is still necessary on the potential of mean diffusivity (MD) sensitivity for detecting early changes. The majority of the included studies demonstrated progressive changes in DTI parameters over time and with dose. Conclusion: There is significant potential for DTI biomarkers to predict WM changes caused by radiation after brain radiation therapy by having significant predictive power.