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@ARTICLE{Kocher:902215,
      author       = {Kocher, Martin and Jockwitz, Christiane and Lerche,
                      Christoph and Sabel, Michael and Lohmann, Philipp and
                      Stoffels, Gabriele and Filss, Christian and Mottaghy, Felix
                      M. and Ruge, Maximilian I. and Fink, Gereon R. and Shah,
                      Nadim J. and Galldiks, Norbert and Caspers, Svenja and
                      Langen, Karl-Josef},
      title        = {{C}ase {R}eport: {D}isruption of {R}esting-{S}tate
                      {N}etworks and {C}ognitive {D}eficits {A}fter {W}hole
                      {B}rain {I}rradiation for {S}ingular {B}rain {M}etastasis},
      journal      = {Frontiers in neuroscience},
      volume       = {15},
      issn         = {1662-453X},
      address      = {Lausanne},
      publisher    = {Frontiers Research Foundation},
      reportid     = {FZJ-2021-04103},
      pages        = {738708},
      year         = {2021},
      abstract     = {Introduction: Long-term survivors of whole brain radiation
                      (WBRT) are at significant risk for developing cognitive
                      deficits, but knowledge about the underlying
                      pathophysiological mechanisms is limited. Therefore, we here
                      report a rare case with a singular brain metastasis treated
                      by resection and WBRT that survived for more than 10 years
                      where we investigated the integrity of brain networks using
                      resting-state functional MRI.Methods: A female patient with
                      a left frontal non-small cell lung cancer (NSCLC) brain
                      metastasis had resection and postoperative WBRT (30.0 in 3.0
                      Gy fractions) and stayed free from brain metastasis
                      recurrence for a follow-up period of 11 years. Structural
                      magnetic resonance imaging (MRI) and amino acid
                      [O-(2-[18F]fluoroethyl)-L-tyrosine] positron emission
                      tomography (FET PET) were repeatedly acquired. At the last
                      follow up, neurocognitive functions and resting-state
                      functional connectivity (RSFC) using resting-state fMRI were
                      assessed. Within-network and inter-network connectivity of
                      seven resting-state networks were computed from a
                      connectivity matrix. All measures were compared to a matched
                      group of 10 female healthy subjects.Results: At the 11-year
                      follow-up, T2/FLAIR MR images of the patient showed extended
                      regions of hyper-intensities covering mainly the white mater
                      of the bilateral dorsal frontal and parietal lobes while
                      sparing most of the temporal lobes. Compared to the healthy
                      subjects, the patient performed significantly worse in all
                      cognitive domains that included executive functions,
                      attention and processing speed, while verbal working memory,
                      verbal episodic memory, and visual working memory were left
                      mostly unaffected. The connectivity matrix showed a heavily
                      disturbed pattern with a widely distributed, scattered loss
                      of RSFC. The within-network RSFC revealed a significant loss
                      of connectivity within all seven networks where the dorsal
                      attention and fronto-parietal control networks were affected
                      most severely. The inter-network RSFC was significantly
                      reduced for the visual, somato-motor, and dorsal and ventral
                      attention networks.Conclusion: As demonstrated here in a
                      patient with a metastatic NSCLC and long-term survival, WBRT
                      may lead to extended white matter damage and cause severe
                      disruption of the RSFC in multiple resting state networks.
                      In consequence, executive functioning which is assumed to
                      depend on the interaction of several networks may be
                      severely impaired following WBRT apart from the
                      well-recognized deficits in memory function.},
      cin          = {INM-4 / INM-11 / JARA-BRAIN / INM-1 / INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-4-20090406 / I:(DE-Juel1)INM-11-20170113 /
                      I:(DE-Juel1)VDB1046 / I:(DE-Juel1)INM-1-20090406 /
                      I:(DE-Juel1)INM-3-20090406},
      pnm          = {5253 - Neuroimaging (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5253},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {34776847},
      UT           = {WOS:000717637300001},
      doi          = {10.3389/fnins.2021.738708},
      url          = {https://juser.fz-juelich.de/record/902215},
}