脑转移瘤是成年人中最常见的颅内肿瘤，与显著的死亡率和死亡率有关。全脑放射治疗（WBRT）常用于治疗病人的临终关怀，但可能导致神经认知缺陷。虽然已经证明了对个体区域（例如海马）的剂量依赖性损伤，但WBRT后全局结构形状的变化仍需研究。我们研究了健康对照组和脑转移瘤患者，并检查了WBRT前后的MRI脑解剖表面数据。我们实施了一种经验证的图形卷积神经网络模型来估计患者的“脑龄”。我们进一步开发了混合效应线性模型，以比较WBRT前后整个大脑和亚结构的估计年龄。共分析了4220名受试者（4148名健康对照组和72名患者）。中位辐射剂量为30Gy（范围为25-37.5Gy）。与健康对照组相比，放射患者的整个大脑和亚结构经历了类似于快速老化的结构性变化；整个大脑“老化”了9.32倍，皮层“老化”了8.05倍，亚皮质结构“老化”了12.57倍，海马“老化”了10.14倍。在子集分析中，常规WBRT后海马“老化”速度为HA-WBRT后的8.88倍。我们的研究结果表明，WBRT使大脑及其亚结构的结构以高达正常衰老速度的13倍的速度发生变化，其中海马避免提供局部结构保护。将这些结构成像变化与WBRT或HA-WBRT后的认知神经结果相关联，将有助于未来的分析。 ©作者（2023）。由牛津大学出版社代表神经肿瘤学会出版。保留所有权利。如需授权，请发送电子邮件至：journals.permissions@oup.com。

Brain metastases are the most common intracranial tumors in adults and are associated with significant morbidity and mortality. Whole brain radiotherapy (WBRT) is used frequently in patients for palliation, but can result in neurocognitive deficits. While dose-dependent injury to individual areas such as the hippocampus have been demonstrated, global structural shape changes after WBRT remain to be studied.We studied healthy controls and patients with brain metastases and examined MRI brain anatomic surface data before and after WBRT. We implemented a validated graph convolutional neural network model to estimate patient's "brain age". We further developed a mixed-effects linear model to compare estimated age of whole brain and substructures before and after WBRT.4220 subjects were analyzed (4148 healthy controls and 72 patients). Median radiation dose was 30Gy (range 25 - 37.5Gy). The whole brain and substructures underwent structural change resembling rapid aging in radiated patients compared to healthy controls; the whole brain "aged" 9.32 times faster, the cortex 8.05 times faster, the subcortical structures 12.57 times faster, and the hippocampus 10.14 times faster. In a subset analysis, the hippocampus "aged" 8.88 times faster in patients after conventional WBRT versus after hippocampal avoidance (HA)-WBRT.Our findings suggest that WBRT causes the brain and its substructures to undergo structural changes at a pace up to 13x of the normal aging pace, where hippocampal avoidance offers focal structural protection. Correlating these structural imaging changes with neurocognitive outcomes following WBRT or HA-WBRT would benefit from future analysis.© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.