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Drabek-Maunder ER, Mankad K, Aquilina K, Dean JA, Nisbet A, Clark CA. Using diffusion MRI to understand white matter damage and the link between brain microstructure and cognitive deficits in paediatric medulloblastoma patients. Eur J Radiol 2024; 177:111562. [PMID: 38901074 DOI: 10.1016/j.ejrad.2024.111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/09/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Survivors of medulloblastoma face a range of challenges after treatment, involving behavioural, cognitive, language and motor skills. Post-treatment outcomes are associated with structural changes within the brain resulting from both the tumour and the treatment. Diffusion magnetic resonance imaging (MRI) has been used to investigate the microstructure of the brain. In this review, we aim to summarise the literature on diffusion MRI in patients treated for medulloblastoma and discuss future directions on how diffusion imaging can be used to improve patient quality. METHOD This review summarises the current literature on medulloblastoma in children, focusing on the impact of both the tumour and its treatment on brain microstructure. We review studies where diffusion MRI has been correlated with either treatment characteristics or cognitive outcomes. We discuss the role diffusion MRI has taken in understanding the relationship between microstructural damage and cognitive and behavioural deficits. RESULTS We identified 35 studies that analysed diffusion MRI changes in patients treated for medulloblastoma. The majority of these studies found significant group differences in measures of brain microstructure between patients and controls, and some of these studies showed associations between microstructure and neurocognitive outcomes, which could be influenced by patient characteristics (e.g. age), treatment, radiation dose and treatment type. CONCLUSIONS In future, studies would benefit from being able to separate microstructural white matter damage caused by the tumour, tumour-related complications and treatment. Additionally, advanced diffusion modelling methods can be explored to understand and describe microstructural changes to white matter.
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Affiliation(s)
- Emily R Drabek-Maunder
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; UCL Dept of Medical Physics and Biomedical Engineering, Malet Place, Gower St, London WC1E 6BT, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
| | - Kshitij Mankad
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - Kristian Aquilina
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - Jamie A Dean
- UCL Dept of Medical Physics and Biomedical Engineering, Malet Place, Gower St, London WC1E 6BT, UK
| | - Andrew Nisbet
- UCL Dept of Medical Physics and Biomedical Engineering, Malet Place, Gower St, London WC1E 6BT, UK
| | - Chris A Clark
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
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Mughal ZUN, Malik A, Zainulabedin F. Letter to editor: Volumetric segmentation in the context of posterior fossa‑related pathologies: a systematic review. Neurosurg Rev 2024; 47:226. [PMID: 38771377 DOI: 10.1007/s10143-024-02466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/25/2024] [Accepted: 05/18/2024] [Indexed: 05/22/2024]
Abstract
This letter provides feedback on the article titled "Volumetric Segmentation in the Context of Posterior Fossa-Related Pathologies: A Systematic Review." It highlights the positive impacts of the review, such as its comprehensive examination of existing literature and its potential to enhance diagnostic accuracy and treatment planning. However, it also addresses limitations and challenges associated with volumetric segmentation, including variability in image quality and accessibility issues.
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Affiliation(s)
- Zaib Un Nisa Mughal
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan.
| | - Abdul Malik
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan
| | - Fatema Zainulabedin
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan
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Kobets AJ, Alavi SAN, Ahmad SJ, Castillo A, Young D, Minuti A, Altschul DJ, Zhu M, Abbott R. Volumetric segmentation in the context of posterior fossa-related pathologies: a systematic review. Neurosurg Rev 2024; 47:170. [PMID: 38637466 PMCID: PMC11026186 DOI: 10.1007/s10143-024-02366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Segmentation tools continue to advance, evolving from manual contouring to deep learning. Researchers have utilized segmentation to study a myriad of posterior fossa-related conditions, such as Chiari malformation, trigeminal neuralgia, post-operative pediatric cerebellar mutism syndrome, and Crouzon syndrome. Herein, we present a summary of the current literature on segmentation of the posterior fossa. The review highlights the various segmentation techniques, and their respective strengths and weaknesses, employed along with objectives and outcomes of the various studies reported in the literature. METHODS A literature search was conducted in PubMed, Embase, Cochrane, and Web of Science up to November 2023 for articles on segmentation techniques of posterior fossa. The two senior authors searched through databases based on the keywords of the article separately and then enrolled joint articles that met the inclusion and exclusion criteria. RESULTS The initial search identified 2205 articles. After applying inclusion and exclusion criteria, 77 articles were selected for full-text review after screening of titles/abstracts. 52 articles were ultimately included in the review. Segmentation techniques included manual, semi-automated, and fully automated (atlas-based, convolutional neural networks). The most common pathology investigated was Chiari malformation. CONCLUSIONS Various forms of segmentation techniques have been used to assess posterior fossa volumes/pathologies and each has its advantages and disadvantages. We discuss these nuances and summarize the current state of literature in the context of posterior fossa-associated pathologies.
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Affiliation(s)
- Andrew J Kobets
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA
| | - Seyed Ahmad Naseri Alavi
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA.
| | | | | | | | | | - David J Altschul
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA
| | - Michael Zhu
- Albert Einstein College of Medicine, New York City, USA
| | - Rick Abbott
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA
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Lassaletta Á, Morales JS, Valenzuela PL, Esteso B, Kahalley LS, Mabbott DJ, Unnikrishnan S, Panizo E, Calvo F. Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis. World J Pediatr 2023; 19:727-740. [PMID: 37154861 PMCID: PMC10348930 DOI: 10.1007/s12519-023-00726-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and meta-analysis aimed to compare the neurocognitive outcomes of children and adolescents with brain tumors treated with photon radiation (XRT) or proton therapy (PBRT). METHODS A systematic search was conducted (PubMed, Embase, Cochrane, and Web of Science from inception until 02/01/2022) for studies comparing the neurocognitive outcomes of children and adolescents with brain tumors treated with XRT vs. PBRT. The pooled mean differences (expressed as Z scores) were calculated using a random effects method for those endpoints analyzed by a minimum of three studies. RESULTS Totally 10 studies (n = 630 patients, average age range: 1-20 years) met the inclusion criteria. Patients who had received PBRT achieved significantly higher scores (difference in Z scores ranging from 0.29-0.75, all P < 0.05 and significant in sensitivity analyses) after treatment than those who had received XRT for most analyzed neurocognitive outcomes (i.e., intelligence quotient, verbal comprehension and perceptual reasoning indices, visual motor integration, and verbal memory). No robust significant differences (P > 0.05 in main analyses or sensitivity analyses) were found for nonverbal memory, verbal working memory and working memory index, processing speed index, or focused attention. CONCLUSIONS Pediatric brain tumor patients who receive PBRT achieve significantly higher scores on most neurocognitive outcomes than those who receive XRT. Larger studies with long-term follow-ups are needed to confirm these results.
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Affiliation(s)
- Álvaro Lassaletta
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain.
- Pediatric Neuro-Oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Javier S Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
- Systems Biology Department, University of Alcalá, Madrid, Spain
| | - Borja Esteso
- Clinical Neuropsychology Unit, Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lisa S Kahalley
- Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Donald J Mabbott
- The Hospital for Sick Children, Toronto, ON, Canada
- The University of Toronto, Toronto, ON, Canada
| | | | - Elena Panizo
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain
| | - Felipe Calvo
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain
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Oyefiade A, Parthab N, Skocic J, Moxon-Emre I, Tabori U, Bouffet E, Ramaswamy V, Laughlin S, Mabbott DJ. Insult to Short-Range White Matter Connectivity in Childhood Brain Tumor Survivors. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00068-8. [PMID: 36706870 DOI: 10.1016/j.ijrobp.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE Children treated for brain tumors are at an increased risk for cognitive impairments due to the effect of radiation therapy on developing white matter (WM). Although damage to long-range WM is well documented in pediatric brain tumor survivors, the effect of radiation therapy on short-range WM remains unelucidated. We sought to clarify whether radiation treatment affects short-range WM by completing a virtual dissection of these connections and comparing their microstructural properties between brain tumor survivors and typically developing children. METHODS AND MATERIALS T1-weighted and diffusion-weighted magnetic resonance images were acquired for 26 brain tumor survivors and 26 typically developing children. Short-range WM was delineated using a novel, whole-brain approach. A random forest classifier was used to identify short-range connections with the largest differences in microstructure between patients and typically developing children. RESULTS The random forest classifier identified differences in short-range WM microstructure across the brain with an accuracy of 87.5%. Nine connections showed the largest differences in short-range WM between patients and typically developing children. For these connections, fractional anisotropy and axial diffusivity were significantly lower in patients. Short-range connections in the posterior fossa were disproportionately affected, suggesting that greater radiation exposure to the posterior fossa was more injurious to short-range WM. Lower craniospinal radiation dose did not predict reduced toxicity to short-range WM. CONCLUSIONS Our findings indicate that treatment for medulloblastoma resulted in changes in short-range WM in patients. Lower fractional anisotropy and axial diffusivity may reflect altered microstructural organization and coherence of these connections, especially in the posterior fossa. Short-range WM may be especially sensitive to the effect of craniospinal radiation therapy, resulting in compromise to these connections regardless of dose.
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Affiliation(s)
- Adeoye Oyefiade
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nadeem Parthab
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jovanka Skocic
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Iska Moxon-Emre
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Divisions of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Divisions of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Divisions of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susanne Laughlin
- Divisions of Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald J Mabbott
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
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Tanedo J, Gajawelli N, Guo S, Baron Nelson M, Lepore N. White matter tract changes in pediatric posterior fossa brain tumor survivors after surgery and chemotherapy. FRONTIERS IN NEUROIMAGING 2022; 1:845609. [PMID: 37555139 PMCID: PMC10406254 DOI: 10.3389/fnimg.2022.845609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/24/2022] [Indexed: 08/10/2023]
Abstract
BACKGROUND Survivors of pediatric posterior fossa brain tumors are susceptible to the adverse effects of treatment as they grow into adulthood. While the exact neurobiological mechanisms of these outcomes are not yet understood, the effects of treatment on white matter (WM) tracts in the brain can be visualized using diffusion tensor (DT) imaging. We investigated these WM microstructural differences using the statistical method tract-specific analysis (TSA). We applied TSA to the DT images of 25 children with a history of posterior fossa tumor (15 treated with surgery, 10 treated with surgery and chemotherapy) along with 21 healthy controls. Between these 3 groups, we examined differences in the most used DTI metric, fractional anisotropy (FA), in 11 major brain WM tracts. RESULTS Lower FA was found in the splenium of the corpus callosum (CC), the bilateral corticospinal tract (CST), the right inferior frontal occipital fasciculus (IFOF) and the left uncinate fasciculus (UF) in children with brain tumors as compared to healthy controls. Lower FA, an indicator of microstructural damage to WM, was observed in 4 of the 11 WM tracts examined in both groups of children with a history of posterior fossa tumor, with an additional tract unique to children who received surgery and chemotherapy (left UF). CONCLUSIONS Our findings indicate that a history of tumor in the posterior fossa and surgical resection may have effects on the WM in other parts of the brain.
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Affiliation(s)
- Jeffrey Tanedo
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Niharika Gajawelli
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sharon Guo
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Mary Baron Nelson
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Natasha Lepore
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Sleurs C, Jacobs S, Counsell SJ, Christiaens D, Tournier JD, Sunaert S, Van Beek K, Uyttebroeck A, Deprez S, Batalle D, Lemiere J. Brain network hubs and cognitive performance of survivors of childhood infratentorial tumors. Radiother Oncol 2021; 161:118-125. [PMID: 34102233 DOI: 10.1016/j.radonc.2021.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 04/09/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Childhood infratentorial tumor patients frequently suffer from long-term cognitive deficits. As each constituent of their treatment can lead to neurotoxicity, cascade effects can lead to profound reorganization of the underlying brain network, the so-called 'connectome'. However, to date, few studies have assessed the relationship between brain network topology, the functional role of network hubs (i.e. highly connected regions), and neurocognitive outcomes in adult survivors of childhood infratentorial tumors. METHODS In this cross-sectional study, childhood infratentorial tumor survivors (n = 21: pilocytic astrocytoma (n = 8), ependymoma (n = 1) and medulloblastoma (n = 12)) and healthy controls (n = 21) were recruited. Using multishell diffusion-weighted MRI, microstructural organization and topology of supratentorial white matter was investigated; using a voxel-based approach, a fixel-based analysis, and a graph theoretical approach. In addition, neurocognitive subscales of the WAIS-IV intelligence test, and their relationship with nodal strength and network efficiency metrics were assessed. RESULTS Similar to earlier studies, we observed widespread decreases in fractional anisotropy (FA) in patients compared to controls, based on voxel-based analyses. In addition, the fixel-based analyses dissociated macro- from microstructural changes, which were encountered in in infratentorial versus supratentorial brain areas, respectively. Finally, regional reorganization (i.e. differences in local efficiency) occurred mainly in hubs, which suggests a specific vulnerability of these areas. These hubs were not only mostly affected, but also most strongly correlated with the intelligence subscales. CONCLUSION This study suggests that network hubs are functionally important for intellectual outcomes in infratentorial tumor survivors. Furthermore, these regions could be the primary targets of treatment toxicity. Validation of this specific hypothesis in larger samples is required.
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Affiliation(s)
| | - Sandra Jacobs
- Department of Oncology, KU Leuven, Belgium; Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Belgium
| | - Serena J Counsell
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Daan Christiaens
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Imaging and Pathology, KU Leuven, Belgium
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Stefan Sunaert
- Department of Radiology, University Hospitals Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Belgium
| | - Karen Van Beek
- Department of Radiotherapy, University Hospitals Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Oncology, KU Leuven, Belgium; Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Belgium
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Jurgen Lemiere
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Belgium
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Weusthof K, Lüttich P, Regnery S, König L, Bernhardt D, Witt O, Herfarth K, Unterberg A, Jungk C, Farnia B, Combs SE, Debus J, Rieken S, Harrabi S, Adeberg S. Neurocognitive Outcomes in Pediatric Patients Following Brain Irradiation. Cancers (Basel) 2021; 13:cancers13143538. [PMID: 34298751 PMCID: PMC8307409 DOI: 10.3390/cancers13143538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/16/2022] Open
Abstract
Advanced radiation techniques can reduce the severity of neurocognitive sequelae in young brain tumor patients. In the present analysis, we sought to compare neurocognitive outcomes after proton irradiation with patients who underwent photon radiotherapy (RT) and surgery. Neurocognitive outcomes were evaluated in 103 pediatric brain tumor patients (proton RT n = 26, photon RT n = 30, surgery n = 47) before and after treatment. Comparison of neurocognitive outcomes following different treatment modalities were analyzed over four years after treatment completion. Longitudinal analyses included 42 months of follow-up after proton RT and 55 months after photon RT and surgery. Neurocognitive assessment included standardized tests examining seven domains. A comparison of neurocognitive outcomes after RT (proton and photon with >90% additional surgery) and surgery showed no significant differences in any neurocognitive domain. Neurocognitive functioning tests after proton RT failed to identify alterations compared to baseline testing. Long-term follow up over four years after photon RT showed a decrease in non-verbal intelligence (-9.6%; p = 0.01) and visuospatial construction (-14.9%; p = 0.02). After surgery, there was a decline in non-verbal intelligence (-10.7%; p = 0.01) and processing speed (14.9%; p = 0.002). Differences in neurocognitive outcomes between RT and surgical cohorts in direct intermodal comparison at long-term follow-up were not identified in our study, suggesting that modern radiation therapy does not affect cognition as much as in the past. There were no alterations in long-term neurocognitive abilities after proton RT, whereas decline of processing speed, non-verbal intelligence, and visuospatial abilities were observed after both photon RT and surgery. Domains dependent on intact white matter structures appear particularly vulnerable to brain tumor treatment irrespective of treatment approach.
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Affiliation(s)
- Katharina Weusthof
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Peggy Lüttich
- Section of Pediatric Brain Tumors, Department of Pediatric Oncology, Hematology and Immunology, University Medical Center for Children and Adolescents, 69120 Heidelberg, Germany; (P.L.); (O.W.)
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Technische Universität München, 81675 München, Germany; (D.B.); (S.E.C.)
- Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Olaf Witt
- Section of Pediatric Brain Tumors, Department of Pediatric Oncology, Hematology and Immunology, University Medical Center for Children and Adolescents, 69120 Heidelberg, Germany; (P.L.); (O.W.)
- Translational Program, Hopp Children’s Cancer Center at NCT Heidelberg (KiTZ), 69120 Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.U.); (C.J.)
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.U.); (C.J.)
| | - Benjamin Farnia
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA;
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technische Universität München, 81675 München, Germany; (D.B.); (S.E.C.)
- Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Goettingen, 37075 Goettingen, Germany;
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-8201
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Beez T, Munoz-Bendix C, Steiger HJ, Hänggi D. Functional tracts of the cerebellum-essentials for the neurosurgeon. Neurosurg Rev 2021; 44:273-278. [PMID: 32056026 PMCID: PMC7851031 DOI: 10.1007/s10143-020-01242-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/01/2020] [Accepted: 01/09/2020] [Indexed: 02/07/2023]
Abstract
The cerebellum is historically implicated in motor coordination, but accumulating modern evidence indicates involvement in non-motor domains, including cognition, emotion, and language. This correlates with the symptoms observed in postoperative cerebellar mutism syndrome (CMS). Profound knowledge of cerebellar functional topography and tractography is important when approaching cerebellar tumors, as surgical trauma to relevant structures of cerebellar pathways plays a role in the pathogenesis of CMS. The aim of this systematic review is to provide a concise overview of relevant modern neuroimaging data and cerebellar functional tracts with regard to neurosurgical procedures.
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Affiliation(s)
- Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Christopher Munoz-Bendix
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Yuan Q, Ma F, Zhang M, Chen M, Zhang Z, Wu J, Lu C, Guo T. Neural interaction between language control and cognitive control: Evidence from cross-task adaptation. Behav Brain Res 2020; 401:113086. [PMID: 33359369 DOI: 10.1016/j.bbr.2020.113086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 01/28/2023]
Abstract
It has been documented that conflict adaptation (conflict resolution in a task enhanced by that in a previous task) exists not only in the same domain but also across different domains with shared cognitive control mechanisms. For the first time, the present study adopted a cross-task adaptive blocked design to examine the relationship between bilingual language control and cognitive control from the perspective of the immediately adjacent, mutual influence on the neural connectivity level. The results showed that the conflict setting induced by previous tasks changed the nodal degrees of the anterior cingulate cortex/presupplementary motor area and the right thalamus, and connectivity strength of shared links between adjacent language and cognitive control tasks. In addition, pre-activation of the cognitive control network affected the transitivity of the successive use of the language control network. These findings not only indicate a cross-task adaptation effect on the neural connectivity level, but also provide evidence for similarities in conflict detection and inhibition control between language-specific control and domain-general cognitive control. In addition, our results also suggest that there is only partial overlap between bilingual language control and domain-general cognitive control.
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Affiliation(s)
- Qiming Yuan
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Fengyang Ma
- School of Education, University of Cincinnati, Cincinnati, USA
| | - Man Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Mo Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Zhaoqi Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Junjie Wu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
| | - Chunming Lu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Taomei Guo
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
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Double Dissociation of Auditory Attention Span and Visual Attention in Long-Term Survivors of Childhood Cerebellar Tumor: A Deterministic Tractography Study of the Cerebellar-Frontal and the Superior Longitudinal Fasciculus Pathways. J Int Neuropsychol Soc 2020; 26:939-953. [PMID: 32342828 DOI: 10.1017/s1355617720000417] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Right cerebellar-left frontal (RC-LF) white matter integrity (WMI) has been associated with working memory. However, prior studies have employed measures of working memory that include processing speed and attention. We examined the relationships between the RC-LF WMI and processing speed, attention, and working memory to clarify the relationship of RC-LF WMI with a specific cognitive function. Right superior longitudinal fasciculus II (SLF II) WMI and visual attention were included as a negative control tract and task to demonstrate a double dissociation. METHODS Adult survivors of childhood brain tumors [n = 29, age: M = 22 years (SD = 5), 45% female] and demographically matched controls were recruited (n = 29). Tests of auditory attention span, working memory, and visual attention served as cognitive measures. Participants completed a 3-T MRI diffusion-weighted imaging scan. Fractional anisotropy (FA) and radial diffusivity (RD) served as WMI measures. Partial correlations between WMI and cognitive scores included controlling for type of treatment. RESULTS A correlational double dissociation was found. RC-LF WMI was associated with auditory attention (FA: r = .42, p = .03; RD: r = -.50, p = .01) and was not associated with visual attention (FA: r = -.11, p = .59; RD: r = -.11, p = .57). SLF II FA WMI was associated with visual attention (FA: r = .44, p = .02; RD: r = -.17, p = .40) and was not associated with auditory attention (FA: r = .24, p = .22; RD: r = -.10, p = .62). CONCLUSIONS The results show that RC-LF WMI is associated with auditory attention span rather than working memory per se and provides evidence for a specificity based on the correlational double dissociation.
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Wende T, Hoffmann KT, Meixensberger J. Tractography in Neurosurgery: A Systematic Review of Current Applications. J Neurol Surg A Cent Eur Neurosurg 2020; 81:442-455. [PMID: 32176926 DOI: 10.1055/s-0039-1691823] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The ability to visualize the brain's fiber connections noninvasively in vivo is relatively young compared with other possibilities of functional magnetic resonance imaging. Although many studies showed tractography to be of promising value for neurosurgical care, the implications remain inconclusive. An overview of current applications is presented in this systematic review. A search was conducted for (("tractography" or "fiber tracking" or "fibre tracking") and "neurosurgery") that produced 751 results. We identified 260 relevant articles and added 20 more from other sources. Most publications concerned surgical planning for resection of tumors (n = 193) and vascular lesions (n = 15). Preoperative use of transcranial magnetic stimulation was discussed in 22 of these articles. Tractography in skull base surgery presents a special challenge (n = 29). Fewer publications evaluated traumatic brain injury (TBI) (n = 25) and spontaneous intracranial bleeding (n = 22). Twenty-three articles focused on tractography in pediatric neurosurgery. Most authors found tractography to be a valuable addition in neurosurgical care. The accuracy of the technique has increased over time. There are articles suggesting that tractography improves patient outcome after tumor resection. However, no reliable biomarkers have yet been described. The better rehabilitation potential after TBI and spontaneous intracranial bleeding compared with brain tumors offers an insight into the process of neurorehabilitation. Tractography and diffusion measurements in some studies showed a correlation with patient outcome that might help uncover the neuroanatomical principles of rehabilitation itself. Alternative corticofugal and cortico-cortical networks have been implicated in motor recovery after ischemic stroke, suggesting more complex mechanisms in neurorehabilitation that go beyond current models. Hence tractography may potentially be able to predict clinical deficits and rehabilitation potential, as well as finding possible explanations for neurologic disorders in retrospect. However, large variations of the results indicate a lack of data to establish robust diagnostical concepts at this point. Therefore, in vivo tractography should still be interpreted with caution and by experienced surgeons.
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Affiliation(s)
- Tim Wende
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
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Ailion AS, Roberts SR, Crosson B, King TZ. Neuroimaging of the component white matter connections and structures within the cerebellar-frontal pathway in posterior fossa tumor survivors. NEUROIMAGE-CLINICAL 2019; 23:101894. [PMID: 31229941 PMCID: PMC6593203 DOI: 10.1016/j.nicl.2019.101894] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/07/2019] [Accepted: 06/08/2019] [Indexed: 12/11/2022]
Abstract
Introduction In posterior fossa tumor survivors, lower white matter integrity (WMI) in the right cerebellar-left frontal pathway has been well documented and appears to be related to proximity to the cerebellum, radiation treatment, as well as time since treatment in both cranial radiation and surgery-only treatment groups. The current study investigated theories of transneural degeneration following cerebellar tumor resection that may underlie or relate to reductions in WMI and regional brain volumes using correlations. We hypothesized a positive relationship between the volume of the right cerebellum and known white matter output pathways, as well as with the volume of structures that receive cerebellar projections along the pathway. Methods Adult survivors of childhood brain tumors were recruited (n = 29; age, M = 22 years, SD = 5; 45% female). Age- and gender-matched controls were also included (n = 29). Participants completed 3 T diffusion-weighted and T1 MPRAGE MRI scans. Brain structure volume relative to intracranial vault served as regional volumetric measures. Fractional anisotropy (FA) and radial diffusivity (RD) served as WMI measures. In the survivor group, partial correlations between WMI and regional volume included controlling for disease severity. Results In posterior fossa tumor survivors, the volumes of the cerebellum, thalamus, and frontal lobe were correlated with WMI of the thalamic-frontal segment of the cerebellar-frontal pathway (r = 0.41–0.49, p < .05). Cerebellar atrophy was correlated with reduced WMI in the cerebellar-rubral segment (FA, r = −0.32 p > .05; RD, r = 0.53, p < .01). In the no-radiation survivor group, the regional volume of each structure along the pathway was associated with WMI in the cerebellar-rubral segment. In the radiation survivor group, significant correlations were found between the regional brain volume of each structure and the thalamic-frontal segment of the pathway. Discussion The results of this multimodal neuroimaging study provide correlational evidence that the mechanism of injury subsequent to brain tumor treatment may be different depending on type of treatment(s). Without radiation, the primary mechanism of injury is cerebellar tumor growth, resection, and hydrocephalus. Therefore, the most proximal connection to that injury (cerebellar-rubral pathway) was correlated with reductions in volume along the pathway. In contrast, the survivor group treated with radiation may have had possible radiation-induced demyelination of the thalamic-frontal portion of the pathway, based on a strong correlation with volume loss in the cerebellum, red nucleus, thalamus, and frontal lobe. Cerebellar atrophy predicted lower white matter integrity (WMI) in the cerebellar-rubral segment. The no-radiation group showed a correlational pattern that is consistent with possible transneural degeneration. The radiation group showed a correlational pattern consistent with theories of neurodevelopmental vulnerability to radiation-induced demyelination.
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Affiliation(s)
- Alyssa S Ailion
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America
| | - Simone Renée Roberts
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America; Department of Neurology, Emory University School of Medicine, United States of America; Atlanta VA Center of Excellence for Visual and Neurocognitive Rehabilitation, United States of America
| | - Bruce Crosson
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America; Department of Radiology and Imaging Sciences, Emory University School of Medicine, United States of America; Department of Neurology, Emory University School of Medicine, United States of America; Atlanta VA Center of Excellence for Visual and Neurocognitive Rehabilitation, United States of America
| | - Tricia Z King
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America.
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Ji Q, Edwards A, Glass JO, Brinkman TM, Patay Z, Reddick WE. Measurement of Projections Between Dentate Nucleus and Contralateral Frontal Cortex in Human Brain Via Diffusion Tensor Tractography. THE CEREBELLUM 2019; 18:761-769. [DOI: 10.1007/s12311-019-01035-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Schreiber JE, Palmer SL, Conklin HM, Mabbott DJ, Swain MA, Bonner MJ, Chapieski ML, Huang L, Zhang H, Gajjar A. Posterior fossa syndrome and long-term neuropsychological outcomes among children treated for medulloblastoma on a multi-institutional, prospective study. Neuro Oncol 2018; 19:1673-1682. [PMID: 29016818 DOI: 10.1093/neuonc/nox135] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Patients treated for medulloblastoma who experience posterior fossa syndrome (PFS) demonstrate increased risk for neurocognitive impairment at one year post diagnosis. The aim of the study was to examine longitudinal trajectories of neuropsychological outcomes in patients who experienced PFS compared with patients who did not. Methods Participants were 36 patients (22 males) who experienced PFS and 36 comparison patients (21 males) who were matched on age at diagnosis and treatment exposure but did not experience PFS. All patients underwent serial evaluation of neurocognitive functioning spanning 1 to 5 years post diagnosis. Results The PFS group demonstrated lower estimated mean scores at 1, 3, and 5 years post diagnosis on measures of general intellectual ability, processing speed, broad attention, working memory, and spatial relations compared with the non-PFS group. The PFS group exhibited estimated mean scores that were at least one standard deviation below the mean for intellectual ability, processing speed, and broad attention across all time points and for working memory by 5 years post diagnosis. Processing speed was stable over time. Attention and working memory declined over time. Despite some change over time, caregiver ratings of executive function and behavior problem symptoms remained within the average range. Conclusion Compared with patients who do not experience PFS, patients who experience PFS exhibit greater neurocognitive impairment, show little recovery over time, and decline further in some domains. Findings highlight the particularly high risk for long-term neurocognitive problems in patients who experience PFS and the need for close follow-up and intervention.
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Affiliation(s)
- Jane E Schreiber
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Shawna L Palmer
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Heather M Conklin
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Donald J Mabbott
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Michelle A Swain
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Melanie J Bonner
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Mary L Chapieski
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Lu Huang
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Hui Zhang
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Amar Gajjar
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
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Conventional MRI. HANDBOOK OF CLINICAL NEUROLOGY 2018. [PMID: 29903441 DOI: 10.1016/b978-0-444-63956-1.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Conventional magnetic resonance imaging (MRI) allows for a detailed noninvasive visualization/examination of posterior fossa structures and represents a fundamental step in the diagnostic workup of many cerebellar disorders. In the first part of this chapter methodologic issues, like the correct choice of hardware (magnets, coils), pro and cons of the different MRI sequences, and patient management during the examination are discussed. In the second part, the MRI anatomy of the cerebellum, as noted on the various conventional MRI sequences, as well as a detailed description of cerebellar maturational processes from birth to childhood and into adulthood, are reported. Volumetric studies on the cerebellar growth based on three-dimensional MRI sequences are also presented. Moreover, we briefly discuss two main topics regarding conventional MRI of the cerebellum that have generated some debate in recent years: the differentiation between cerebellar atrophy, hypoplasia, and pontocerebellar hypoplasia, and signal changes of dentate nuclei after repetitive gadolinium-based contrast injections. The advantages and benefits of advanced neuroimaging techniques, including 1H magnetic resonance spectroscopy, diffusion-weighted imaging, diffusion tensor imaging, and perfusion-weighted imaging are discussed in the last section of the chapter.
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Glass JO, Ogg RJ, Hyun JW, Harreld JH, Schreiber JE, Palmer SL, Li Y, Gajjar AJ, Reddick WE. Disrupted development and integrity of frontal white matter in patients treated for pediatric medulloblastoma. Neuro Oncol 2018; 19:1408-1418. [PMID: 28541578 DOI: 10.1093/neuonc/nox062] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Treatment of pediatric medulloblastoma is associated with known neurocognitive deficits that we hypothesize are caused by microstructural damage to frontal white matter (WM). Methods Longitudinal MRI examinations were collected from baseline (after surgery but before therapy) to 36 months in 146 patients and at 3 time points in 72 controls. Regional analyses of frontal WM volume and diffusion tensor imaging metrics were performed and verified with tract-based spatial statistics. Age-adjusted, linear mixed-effects models were used to compare patient and control images and to associate imaging changes with Woodcock-Johnson Tests of Cognitive Abilities. Results At baseline, WM volumes in patients were similar to those in controls; fractional anisotropy (FA) was lower bilaterally (P < 0.001) and was associated with decreased Processing Speed (P = 0.014) and Broad Attention (P = 0.025) performance at 36 months. During follow-up, WM volumes increased in controls but decreased in patients (P < 0.001) bilaterally. Smaller WM volumes in patients at 36 months were associated with concurrent decreased Working Memory (P = 0.026) performance. Conclusions Lower FA in patients with pediatric medulloblastoma compared with age-similar controls indicated that patients suffer substantial acute microstructural damage to supratentorial frontal WM following surgery but before radiation therapy or chemotherapy. Additionally, this damage to the frontal WM was associated with decreased cognitive performance in executive function 36 months later. This early damage also likely contributed to posttherapeutic failure of age-appropriate WM development and to the known association between decreased WM volumes and decreased cognitive performance.
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Affiliation(s)
- John O Glass
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Robert J Ogg
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jung W Hyun
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Julie H Harreld
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jane E Schreiber
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Shawna L Palmer
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Yimei Li
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar J Gajjar
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Wilburn E Reddick
- Departments of Diagnostic Imaging, Biostatistics, Psychology, and Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
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Repairing the brain with physical exercise: Cortical thickness and brain volume increases in long-term pediatric brain tumor survivors in response to a structured exercise intervention. NEUROIMAGE-CLINICAL 2018; 18:972-985. [PMID: 29876282 PMCID: PMC5987848 DOI: 10.1016/j.nicl.2018.02.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/23/2017] [Accepted: 02/21/2018] [Indexed: 12/03/2022]
Abstract
There is growing evidence that exercise induced experience dependent plasticity may foster structural and functional recovery following brain injury. We examined the efficacy of exercise training for neural and cognitive recovery in long-term pediatric brain tumor survivors treated with radiation. We conducted a controlled clinical trial with crossover of exercise training (vs. no training) in a volunteer sample of 28 children treated with cranial radiation for brain tumors (mean age = 11.5 yrs.; mean time since diagnosis = 5.7 yrs). The endpoints were anatomical T1 MRI data and multiple behavioral outcomes presenting a broader analysis of structural MRI data across the entire brain. This included an analysis of changes in cortical thickness and brain volume using automated, user unbiased approaches. A series of general linear mixed effects models evaluating the effects of exercise training on cortical thickness were performed in a voxel and vertex-wise manner, as well as for specific regions of interest. In exploratory analyses, we evaluated the relationship between changes in cortical thickness after exercise with multiple behavioral outcomes, as well as the relation of these measures at baseline. Exercise was associated with increases in cortical thickness within the right pre and postcentral gyri. Other notable areas of increased thickness related to training were present in the left pre and postcentral gyri, left temporal pole, left superior temporal gyrus, and left parahippocampal gyrus. Further, we observed that compared to a separate cohort of healthy children, participants displayed multiple areas with a significantly thinner cortex prior to training and fewer differences following training, indicating amelioration of anatomical deficits. Partial least squares analysis (PLS) revealed specific patterns of relations between cortical thickness and various behavioral outcomes both after training and at baseline. Overall, our results indicate that exercise training in pediatric brain tumor patients treated with radiation has a beneficial impact on brain structure. We argue that exercise training should be incorporated into the development of neuro-rehabilitative treatments for long-term pediatric brain tumor survivors and other populations with acquired brain injury. (ClinicalTrials.gov, NCT01944761) Exercise training in pediatric brain tumor patients treated with radiation results in changes in brain structure Exercise was associated with increased cortical thickness in several areas including motor and somatosensory cortex Fewer differences between patients and healthy controls in cortical thickness were seen following exercise training Specific patterns of relations between cortical thickness and behavior at a baseline and after exercise training were seen
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Changes in White Matter Microstructure Impact Cognition by Disrupting the Ability of Neural Assemblies to Synchronize. J Neurosci 2017; 37:8227-8238. [PMID: 28743724 DOI: 10.1523/jneurosci.0560-17.2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 12/27/2022] Open
Abstract
Cognition is compromised by white matter (WM) injury but the neurophysiological alterations linking them remain unclear. We hypothesized that reduced neural synchronization caused by disruption of neural signal propagation is involved. To test this, we evaluated group differences in: diffusion tensor WM microstructure measures within the optic radiations, primary visual area (V1), and cuneus; neural phase synchrony to a visual attention cue during visual-motor task; and reaction time to a response cue during the same task between 26 pediatric patients (17/9: male/female) treated with cranial radiation treatment for a brain tumor (12.67 ± 2.76 years), and 26 healthy children (16/10: male/female; 12.01 ± 3.9 years). We corroborated our findings using a corticocortical computational model representing perturbed signal conduction from myelin. Patients show delayed reaction time, WM compromise, and reduced phase synchrony during visual attention compared with healthy children. Notably, using partial least-squares-path modeling we found that WM insult within the optic radiations, V1, and cuneus is a strong predictor of the slower reaction times via disruption of neural synchrony in visual cortex. Observed changes in synchronization were reproduced in a computational model of WM injury. These findings provide new evidence linking cognition with WM via the reliance of neural synchronization on propagation of neural signals.SIGNIFICANCE STATEMENT By comparing brain tumor patients to healthy children, we establish that changes in the microstructure of the optic radiations and neural synchrony during visual attention predict reaction time. Furthermore, by testing the directionality of these links through statistical modeling and verifying our findings with computational modeling, we infer a causal relationship, namely that changes in white matter microstructure impact cognition in part by disturbing the ability of neural assemblies to synchronize. Together, our human imaging data and computer simulations show a fundamental connection between WM microstructure and neural synchronization that is critical for cognitive processing.
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Ailion AS, Hortman K, King TZ. Childhood Brain Tumors: a Systematic Review of the Structural Neuroimaging Literature. Neuropsychol Rev 2017. [DOI: 10.1007/s11065-017-9352-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Oh ME, Driever PH, Khajuria RK, Rueckriegel SM, Koustenis E, Bruhn H, Thomale UW. DTI fiber tractography of cerebro-cerebellar pathways and clinical evaluation of ataxia in childhood posterior fossa tumor survivors. J Neurooncol 2016; 131:267-276. [DOI: 10.1007/s11060-016-2290-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/09/2016] [Indexed: 11/28/2022]
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Fiori S, Poretti A, Pannek K, Del Punta R, Pasquariello R, Tosetti M, Guzzetta A, Rose S, Cioni G, Battini R. Diffusion Tractography Biomarkers of Pediatric Cerebellar Hypoplasia/Atrophy: Preliminary Results Using Constrained Spherical Deconvolution. AJNR Am J Neuroradiol 2016; 37:917-23. [PMID: 26659337 DOI: 10.3174/ajnr.a4607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/29/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Advances in MR imaging modeling have improved the feasibility of reconstructing crossing fibers, with increasing benefits in delineating angulated tracts such as cerebellar tracts by using tractography. We hypothesized that constrained spherical deconvolution-based probabilistic tractography could successfully reconstruct cerebellar tracts in children with cerebellar hypoplasia/atrophy and that diffusion scalars of the reconstructed tracts could differentiate pontocerebellar hypoplasia, nonprogressive cerebellar hypoplasia, and progressive cerebellar atrophy. MATERIALS AND METHODS Fifteen children with cerebellar ataxia and pontocerebellar hypoplasia, nonprogressive cerebellar hypoplasia or progressive cerebellar atrophy and 7 controls were included in this study. Cerebellar and corticospinal tracts were reconstructed by using constrained spherical deconvolution. Scalar measures (fractional anisotropy and mean, axial and radial diffusivity) were calculated. A general linear model was used to determine differences among groups for diffusion MR imaging scalar measures, and post hoc pair-wise comparisons were performed. RESULTS Cerebellar and corticospinal tracts were successfully reconstructed in all subjects. Significant differences in diffusion MR imaging scalars were found among groups, with fractional anisotropy explaining the highest variability. All groups with cerebellar pathologies showed lower fractional anisotropy compared with controls, with the exception of cerebellar hypoplasia. CONCLUSIONS This study shows the feasibility of constrained spherical deconvolution to reconstruct cerebellar and corticospinal tracts in children with morphologic cerebellar pathologies. In addition, the preliminary results show the potential utility of quantitative analysis of scalars of the cerebellar white matter tracts in children with cerebellar pathologies such as cerebellar hypoplasia and atrophy. Further studies with larger cohorts of patients are needed to validate the clinical significance of our preliminary results.
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Affiliation(s)
- S Fiori
- From Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris Foundation (S.F., R.D.P., R.P., M.T., A.G., G.C., R.B.), Pisa, Italy
| | - A Poretti
- Section of Pediatric Neuroradiology (A.P.), Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - K Pannek
- Commonwealth Scientific and Industrial Research Organization (K.P., S.R.), Centre for Computational Informatics, Brisbane, Australia Department of Computing (K.P.), Imperial College London, London, United Kingdom
| | - R Del Punta
- From Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris Foundation (S.F., R.D.P., R.P., M.T., A.G., G.C., R.B.), Pisa, Italy
| | - R Pasquariello
- From Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris Foundation (S.F., R.D.P., R.P., M.T., A.G., G.C., R.B.), Pisa, Italy
| | - M Tosetti
- From Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris Foundation (S.F., R.D.P., R.P., M.T., A.G., G.C., R.B.), Pisa, Italy
| | - A Guzzetta
- From Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris Foundation (S.F., R.D.P., R.P., M.T., A.G., G.C., R.B.), Pisa, Italy Department of Clinical and Experimental Medicine (A.G., G.C.), University of Pisa, Pisa, Italy
| | - S Rose
- Commonwealth Scientific and Industrial Research Organization (K.P., S.R.), Centre for Computational Informatics, Brisbane, Australia
| | - G Cioni
- From Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris Foundation (S.F., R.D.P., R.P., M.T., A.G., G.C., R.B.), Pisa, Italy Department of Clinical and Experimental Medicine (A.G., G.C.), University of Pisa, Pisa, Italy
| | - R Battini
- From Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris Foundation (S.F., R.D.P., R.P., M.T., A.G., G.C., R.B.), Pisa, Italy
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Law N, Smith ML, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Malkin D, Liu F, Moxon-Emre I, Scantlebury N, Mabbott D. Executive function in paediatric medulloblastoma: The role of cerebrocerebellar connections. J Neuropsychol 2015; 11:174-200. [DOI: 10.1111/jnp.12082] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 06/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Nicole Law
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
- Department of Psychology; Hospital for Sick Children; Toronto Ontario Canada
| | - Mark Greenberg
- Pediatric Oncology Group of Ontario; Toronto Ontario Canada
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
| | - Eric Bouffet
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
| | - Michael D. Taylor
- Division of Neurosurgery; Arthur and Sonia Labatt Brain Tumor Research Centre; Hospital for Sick Children; Toronto Ontario Canada
- Program in Developmental and Stem Cell Biology; Hospital for Sick Children; Toronto Ontario Canada
| | - Suzanne Laughlin
- Diagnostic Imaging; Hospital for Sick Children; Toronto Ontario Canada
| | - David Malkin
- Pediatric Oncology Group of Ontario; Toronto Ontario Canada
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
- Genetics and Genome Biology Program; Hospital for Sick Children; Toronto Ontario Canada
- Department of Pediatrics; University of Toronto; Ontario Canada
| | - Fang Liu
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
| | - Iska Moxon-Emre
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
- Pediatric Oncology Group of Ontario; Toronto Ontario Canada
| | - Nadia Scantlebury
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
| | - Donald Mabbott
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
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