Neuroimaging advances in chemotherapy-related cognitive impairment: from clinical to preclinical research

Chemotherapy-related cognitive impairment (CRCI) is a common complication in patients with non-central nervous system malignancies after chemotherapy and significantly impacts the quality of life of survivors. It is essential to understand the neuroimaging mechanism of CRCI to provide a theoretical basis for clinical rehabilitation strategies as the number of survivors at risk for acute and long-term CRCI is increasing dramatically. In this review, we summarize the main neuroimaging features and findings of clinical patients and preclinical animals with CRCI from structural and functional measurements to molecular imaging, from regional to network-based large-scale analysis, from metabolite concentration to blood perfusion status, and from single-modal group-level statistics to multimodal and individual prediction, with the aim to elaborate on multiple-image signatures of patients and animals with cognitive impairment induced by chemotherapy. In addition, the emerging trend of neuroimaging applications in the comprehensive multimodal and individual prediction in patients with CRCI is addressed. Overall, the review explored the heterogeneity of neuropathological mechanisms of CRCI with neuroimaging technology and verified the findings from clinical to preclinical research. The neuropathological mechanism of CRCI involves abnormal alterations not only in morphology, structure, and functions but also in neuro-electrophysiology, biochemical metabolites, and blood perfusion in related brain regions associated with cognition. We conclude that neuroimaging techniques, particularly multimodal neuroimaging techniques, have great potential in identifying underlying neurobiological alterations associated with CRCI. Longitudinal studies with larger sample sizes combined with individual predictions and molecular imaging technology are still warranted to prove their practical utility for more medications than just chemotherapy.