Spectroscopic imaging of radiation-induced effects in the white matter of glioma patients

External radiation therapy of brain tumors may cause adverse effects on normal brain tissue, resulting in severe neuropsychological and cognitive impairment. We investigated the late delayed radiation effects in the white matter (WM) using 1H magnetic resonance spectroscopic imaging (1HMRSI). Nine glioma patients with local radiation-induced signal abnormalities in the T2-weighted MR images were studied with nine age- and sex-matched controls. The metabolite ratios in the radiation-induced hyper intensity area (RIHA) and in the normal appearing white matter (NAWM) of the patients were compared with respective WM areas of the controls. In RIHA, choline/creatine (Cho/Cr) was 17% decreased (1.22 ± 0.13 vs 1.47 ± 0.16, p = 0.0027, significant (s), unpaired Student’s t test with Bonferroni correction) in the patients compared to the controls, while there was no difference in N-acetyl aspartate/Cr (NAA/Cr) (2.49 ± 0.57 vs 2.98 ± 0.32, p = 0.039) or NAA/Cho (2.03 ± 0.40 vs 2.04 ± 0.17, p = 0.95). In NAWM, Cho/Cr was 24% decreased (1.21 ± 0.15 vs 1.59 ± 0.13, p < 0.0001, s) and NAA/Cho was 20% increased (2.49 ± 0.49 vs 1.98 ± 0.15, p = 0.0082, s) in the patients compared to the controls, while there was no difference in NAA/Cr (2.99 ± 0.46 vs 3.16 ± 0.32, p = 0.38). NAARIHA/NAANAWM was 25% decreased (0.75 ± 0.20 vs 1.00 ± 0.12, p = 0.0043, s) and CrRIHA/CrNAWM was 16% decreased (0.89 ± 0.15 vs 1.06 ± 0.10, p = 0.013, s) in the patients compared to the controls, while there was no difference in ChoRIHA/ChoNAWM (0.92 ± 0.23 vs 0.98 ± 0.10, p = 0.47). 1HMRSI reveals widespread chemical changes in the WM after radiation therapy. In RIHA, there is loss of NAA, Cho, and Cr implying axonal and membrane damage and in NAWM, there is loss of Cho, reflecting membrane damage.