{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:50:03Z","timestamp":1793508603913,"version":"4.5.0"},"reference-count":49,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82071883"],"award-info":[{"award-number":["82071883"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82371937"],"award-info":[{"award-number":["82371937"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Human Brain Mapping"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The glymphatic system maintains brain homeostasis through cerebrospinal fluid transport and waste clearance. Its potential involvement in chemotherapy\u2010related cognitive impairment remains largely unexplored due to limited in\u00a0vivo evidence. In this prospective longitudinal study, 126 female breast cancer patients underwent multiparametric brain MRI and neuropsychological assessments at three time points: baseline (\n                    <jats:sc>bc<\/jats:sc>\n                    1), after the first cycle of neoadjuvant chemotherapy (\n                    <jats:sc>bc<\/jats:sc>\n                    2), and upon completion of neoadjuvant chemotherapy (\n                    <jats:sc>bc<\/jats:sc>\n                    3). Glymphatic function was assessed using four MRI\u2010derived metrics: choroid plexus (CP) volume, perivascular space (PVS) volume fraction, free water (FW), and Diffusion Tensor Imaging\u2013Along the Perivascular Space (DTI\u2010ALPS) index. Brain tissue segmentation was conducted to quantify the volume fractions of gray matter (GM) in cortex and subcortex, white matter (WM), and cerebrospinal fluid (CSF) relative to intracranial volume. Neuropsychological assessments included the Self\u2010Rating Anxiety Scale (SAS), the Functional Assessment of Cancer Therapy\u2013Cognitive Function (FACT\u2010Cog), and a battery of objective cognitive tests. Longitudinal changes and interrelationships were analyzed using linear mixed\u2010effects models, correlation analyses, and cross\u2010lagged panel analysis. During chemotherapy, CP volume increased (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), while PVS volume fraction decreased (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003); no significant changes were found in FW or DTI\u2010ALPS. GM volumes in both cortex and subcortex declined (both\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02). SAS scores increased (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02), and FACT\u2010Cog scores decreased (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), with no significant changes in objective test scores. From\n                    <jats:sc>bc<\/jats:sc>\n                    2 to\n                    <jats:sc>bc<\/jats:sc>\n                    3, increases in CP volume were negatively correlated with reductions in PVS volume fraction (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u2009\u22120.40,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). From\n                    <jats:sc>bc<\/jats:sc>\n                    1 to\n                    <jats:sc>bc<\/jats:sc>\n                    3, reductions in PVS volume fraction were associated with decreases in both cortical GM volumes (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.32,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). At\n                    <jats:sc>bc<\/jats:sc>\n                    2, cortical GM atrophy was correlated with increased SAS scores (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u2009\u22120.30,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). Cross\u2010lagged panel analysis showed that CP enlargement at\n                    <jats:sc>bc<\/jats:sc>\n                    2 preceded PVS volume fraction reduction at\n                    <jats:sc>bc<\/jats:sc>\n                    3 (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u2009\u22121.66,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007). During neoadjuvant chemotherapy, breast cancer patients exhibited a unique pattern of glymphatic system alterations, suggesting its potential as an imaging marker of treatment\u2010related brain changes.\n                  <\/jats:p>","DOI":"10.1002\/hbm.70334","type":"journal-article","created":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T05:35:50Z","timestamp":1756532150000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Glymphatic, Structural, and Cognitive Changes During Breast Cancer Chemotherapy: A Longitudinal\n                    <scp>MRI<\/scp>\n                    Study"],"prefix":"10.1002","volume":"46","author":[{"given":"Xiaoyu","family":"Zhou","sequence":"first","affiliation":[{"name":"School of Medicine Chongqing University  Chongqing China"},{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Hu","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Yang","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine Chongqing University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Lan","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahui","family":"Zheng","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6511-1607","authenticated-orcid":false,"given":"Lin","family":"Tang","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Chen","sequence":"additional","affiliation":[{"name":"Bayer Healthcare  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Yin","sequence":"additional","affiliation":[{"name":"MR Research Collaborations Siemens Healthineers Ltd.  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5606-4394","authenticated-orcid":false,"given":"Daihong","family":"Liu","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0239-6988","authenticated-orcid":false,"given":"Jiuquan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer, Department of Radiology Chongqing University Cancer Hospital  Chongqing 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