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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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2
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Kesler SR, Sleurs C, McDonald BC, Deprez S, van der Plas E, Nieman BJ. Brain Imaging in Pediatric Cancer Survivors: Correlates of Cognitive Impairment. J Clin Oncol 2021; 39:1775-1785. [PMID: 33886371 DOI: 10.1200/jco.20.02315] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell School of Medicine, Livestrong Cancer Institutes, Austin, TX
| | - Charlotte Sleurs
- Department of Oncology, Catholic University of Leuven, Leuven, Belgium.,Leuven Cancer Institute, Leuven, Belgium
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Center for Neuroimaging, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Sabine Deprez
- Leuven Cancer Institute, Leuven, Belgium.,Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Brian J Nieman
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada.,Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
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3
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Ren BX, Huen I, Wu ZJ, Wang H, Duan MY, Guenther I, Bhanu Prakash KN, Tang FR. Early postnatal irradiation-induced age-dependent changes in adult mouse brain: MRI based characterization. BMC Neurosci 2021; 22:28. [PMID: 33882822 PMCID: PMC8061041 DOI: 10.1186/s12868-021-00635-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/13/2021] [Indexed: 02/08/2023] Open
Abstract
Background Brain radiation exposure, in particular, radiotherapy, can induce cognitive impairment in patients, with significant effects persisting for the rest of their life. However, the main mechanisms leading to this adverse event remain largely unknown. A study of radiation-induced injury to multiple brain regions, focused on the hippocampus, may shed light on neuroanatomic bases of neurocognitive impairments in patients. Hence, we irradiated BALB/c mice (male and female) at postnatal day 3 (P3), day 10 (P10), and day 21 (P21) and investigated the long-term radiation effect on brain MRI changes and hippocampal neurogenesis. Results We found characteristic brain volume reductions in the hippocampus, olfactory bulbs, the cerebellar hemisphere, cerebellar white matter (WM) and cerebellar vermis WM, cingulate, occipital and frontal cortices, cerebellar flocculonodular WM, parietal region, endopiriform claustrum, and entorhinal cortex after irradiation with 5 Gy at P3. Irradiation at P10 induced significant volume reduction in the cerebellum, parietal region, cingulate region, and olfactory bulbs, whereas the reduction of the volume in the entorhinal, parietal, insular, and frontal cortices was demonstrated after irradiation at P21. Immunohistochemical study with cell division marker Ki67 and immature marker doublecortin (DCX) indicated the reduced cell division and genesis of new neurons in the subgranular zone of the dentate gyrus in the hippocampus after irradiation at all three postnatal days, but the reduction of total granule cells in the stratum granulosun was found after irradiation at P3 and P10. Conclusions The early life radiation exposure during different developmental stages induces varied brain pathophysiological changes which may be related to the development of neurological and neuropsychological disorders later in life.
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Affiliation(s)
- Bo Xu Ren
- Department of Medical Imaging, School of Medicine, Yangtze University, 1 Nanhuan Road, Jingzhou, 434023, Hubei, China
| | - Isaac Huen
- Singapore Bioimaging Consortium (SBIC), Agency for Science, Technology and Research (A*STAR), Singapore, 138667, Singapore
| | - Zi Jun Wu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Wang
- Radiation Physiology Laboratory, Nuclear Research and Safety Initiative, National University of Singapore, CREATE Tower, 1 CREATE Way #04-01, Singapore, 138602, Singapore
| | - Meng Yun Duan
- Department of Medical Imaging, School of Medicine, Yangtze University, 1 Nanhuan Road, Jingzhou, 434023, Hubei, China
| | - Ilonka Guenther
- Comparative Medicine, Centre for Life Sciences (CeLS), National University of Singapore, #05-02, 28 Medical Drive, Singapore, 117456, Singapore
| | - K N Bhanu Prakash
- Singapore Bioimaging Consortium (SBIC), Agency for Science, Technology and Research (A*STAR), Singapore, 138667, Singapore.
| | - Feng Ru Tang
- Radiation Physiology Laboratory, Nuclear Research and Safety Initiative, National University of Singapore, CREATE Tower, 1 CREATE Way #04-01, Singapore, 138602, Singapore.
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4
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Witzmann K, Raschke F, Troost EGC. MR Image Changes of Normal-Appearing Brain Tissue after Radiotherapy. Cancers (Basel) 2021; 13:cancers13071573. [PMID: 33805542 PMCID: PMC8037886 DOI: 10.3390/cancers13071573] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Radiotherapy is one of the most important treatment options against cancer. Irradiation of cancerous tissue either directly destroys the cancer cells or damages them such that they cannot reproduce. One side-effect of radiotherapy is that tumor-surrounding normal tissue is inevitably also irradiated, albeit at a lower dose. The resulting long-term damage can significantly affect cognitive performance and quality of life. Many studies investigated the effect of irradiation on normal-appearing brain tissues and some of these correlated imaging findings with functional outcome. This article provides an overview of the examination of radiation-induced injuries using conventional and enhanced MRI methods and summarizes conclusions about the underlying tissue changes. Radiation-induced morphologic, microstructural, vascular, and metabolic tissue changes have been observed, in which the effect of irradiation was evident in terms of decreased perfusion and neuronal health as well as increased diffusion and atrophy. Abstract Radiotherapy is part of the standard treatment of most primary brain tumors. Large clinical target volumes and physical characteristics of photon beams inevitably lead to irradiation of surrounding normal brain tissue. This can cause radiation-induced brain injury. In particular, late brain injury, such as cognitive dysfunction, is often irreversible and progressive over time, resulting in a significant reduction in quality of life. Since 50% of patients have survival times greater than six months, radiation-induced side effects become more relevant and need to be balanced against radiation treatment given with curative intent. To develop adequate treatment and prevention strategies, the underlying cause of radiation-induced side-effects needs to be understood. This paper provides an overview of radiation-induced changes observed in normal-appearing brains measured with conventional and advanced MRI techniques and summarizes the current findings and conclusions. Brain atrophy was observed with anatomical MRI. Changes in tissue microstructure were seen on diffusion imaging. Vascular changes were examined with perfusion-weighted imaging and susceptibility-weighted imaging. MR spectroscopy revealed decreasing N-acetyl aspartate, indicating decreased neuronal health or neuronal loss. Based on these findings, multicenter prospective studies incorporating advanced MR techniques as well as neurocognitive function tests should be designed in order to gain more evidence on radiation-induced sequelae.
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Affiliation(s)
- Katharina Witzmann
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany; (K.W.); (F.R.)
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Felix Raschke
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany; (K.W.); (F.R.)
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Esther G. C. Troost
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany; (K.W.); (F.R.)
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden of the German Cancer Research Center (DKFZ), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Correspondence:
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5
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Neuroimaging Biomarkers and Neurocognitive Outcomes in Pediatric Medulloblastoma Patients: a Systematic Review. THE CEREBELLUM 2021; 20:462-480. [PMID: 33417160 DOI: 10.1007/s12311-020-01225-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Medulloblastoma is a malign posterior fossa brain tumor, mostly occurring in childhood. The CNS-directed chemoradiotherapy treatment can be very harmful to the developing brain and functional outcomes of these patients. However, what the underlying neurotoxic mechanisms are remain inconclusive. Hence, this review summarizes the existing literature on the association between advanced neuroimaging and neurocognitive changes in patients that were treated for pediatric medulloblastoma. The PubMed/Medline database was extensively screened for studies investigating the link between cognitive outcomes and multimodal magnetic resonance (MR) imaging in childhood medulloblastoma survivors. A behavioral meta-analysis was performed on the available IQ scores. A total of 649 studies were screened, of which 22 studies were included. Based on this literature review, we conclude medulloblastoma patients to be at risk for white matter volume loss, more frequent white matter lesions, and changes in white matter microstructure. Such microstructural alterations were associated with lower IQ, which reached the clinical cut-off in survivors across studies. Using functional MR scans, changes in activity were observed in cerebellar areas, associated with working memory and processing speed. Finally, cerebral microbleeds were encountered more often, but these were not associated with cognitive outcomes. Regarding intervention studies, computerized cognitive training was associated with changes in prefrontal and cerebellar activation and physical training might result in microstructural and cortical alterations. Hence, to better define the neural targets for interventions in pediatric medulloblastoma patients, this review suggests working towards neuroimaging-based predictions of cognitive outcomes. To reach this goal, large multimodal prospective imaging studies are highly recommended.
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6
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Ottensmeier H, Schlegel PG, Eyrich M, Wolff JE, Juhnke BO, von Hoff K, Frahsek S, Schmidt R, Faldum A, Fleischhack G, von Bueren A, Friedrich C, Resch A, Warmuth-Metz M, Krauss J, Kortmann RD, Bode U, Kühl J, Rutkowski S. Treatment of children under 4 years of age with medulloblastoma and ependymoma in the HIT2000/HIT-REZ 2005 trials: Neuropsychological outcome 5 years after treatment. PLoS One 2020; 15:e0227693. [PMID: 31971950 PMCID: PMC6977734 DOI: 10.1371/journal.pone.0227693] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
Young children with brain tumours are at high risk of developing treatment-related sequelae. We aimed to assess neuropsychological outcomes 5 years after treatment. This cross-sectional study included children under 4 years of age with medulloblastoma (MB) or ependymoma (EP) enrolled in the German brain tumour trials HIT2000 and HIT-REZ2005. Testing was performed using the validated Wuerzburg Intelligence Diagnostics (WUEP-D), which includes Kaufman-Assessment-Battery, Coloured Progressive Matrices, Visual-Motor Integration, finger tapping “Speed”, and the Continuous Performance Test. Of 104 patients in 47 centres, 72 were eligible for analyses. We assessed whether IQ was impacted by disease extent, disease location, patient age, gender, age at surgery, and treatment (chemotherapy with our without craniospinal irradiation [CSI] or local radiotherapy [LRT]). Median age at surgery was 2.3 years. Testing was performed at a median of 4.9 years after surgery. Patients with infratentorial EPs (treated with LRT) scored highest in fluid intelligence (CPM 100.9±16.9, mean±SD); second best scores were achieved by patients with MB without metastasis treated with chemotherapy alone (CPM 93.9±13.2), followed by patients with supratentorial EPs treated with LRT. In contrast, lowest scores were achieved by patients that received chemotherapy and CSI, which included children with metastasised MB and those with relapsed MB M0 (CPM 71.7±8.0 and 73.2±21.8, respectively). Fine motor skills were reduced in all groups. Multivariable analysis revealed that type of treatment had an impact on IQ, but essentially not age at surgery, time since surgery or gender. Our results confirm previous reports on the detrimental effects of CSI in a larger cohort of children. Comparable IQ scores in children with MB treated only with chemotherapy and in children with EP suggest that this treatment strategy represents an attractive option for children who have a high chance to avoid application of CSI. Longitudinal follow-up examinations are warranted to assess long-term neuropsychological outcomes.
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Affiliation(s)
- Holger Ottensmeier
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
- * E-mail:
| | - Paul G. Schlegel
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Medical Center, Wuerzburg, Germany
| | - Matthias Eyrich
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Johannes E. Wolff
- AbbvVie, Oncology Development, Chicago, Illinois, United States of America
| | - Björn-Ole Juhnke
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Frahsek
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Rene Schmidt
- Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | | | - Andre von Bueren
- Department of Paediatrics and Adolescent Medicine Division of Paediatric Haematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Department of Haematology Oncology, University Children´s Hospital Rostock, Rostock, Germany
| | - Anika Resch
- Department of Haematology Oncology, University Children´s Hospital Rostock, Rostock, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, HIT 2000 National Reference Center, University Medical Center Wuerzburg, Wuerzburg, Germany
| | - Jürgen Krauss
- Department of Paediatric Neurosurgery, University of Wuerzburg, University Medical Center Wuerzburg, Wuerzburg, Germany
| | - Rolf D. Kortmann
- Department of Radiotherapy, University of Leipzig, Leipzig, Germany
| | - Udo Bode
- Department of Paediatric Oncology, University of Bonn, Bonn, Germany
| | - Joachim Kühl
- Department of Paediatric Haematology and Oncology, University Children's Hospital, University Medical Center, Wuerzburg, Germany
| | - Stefan Rutkowski
- Department of Paediatric Haematology and Oncology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
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7
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Medulloblastoma in childhood: What effects on neurocognitive functions? Cancer Radiother 2019; 23:370-377. [DOI: 10.1016/j.canrad.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022]
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8
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Nagtegaal SHJ, David S, van der Boog ATJ, Leemans A, Verhoeff JJC. Changes in cortical thickness and volume after cranial radiation treatment: A systematic review. Radiother Oncol 2019; 135:33-42. [PMID: 31015168 DOI: 10.1016/j.radonc.2019.02.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/10/2018] [Accepted: 02/15/2019] [Indexed: 12/23/2022]
Abstract
Cognitive decline has a clear impact on quality of life in patients who have received cranial radiation treatment. The pathophysiological process is most likely multifactorial, with a possible role for decreased cortical thickness and volume. As radiotherapy treatment systems are becoming more sophisticated, precise sparing of vulnerable regions and tissue is possible. This allows radiation oncologists to make treatment more patient-tailored. A systematic search was performed to collect and review all available evidence regarding the effect of cranial radiation treatment on cortical thickness and volume. We searched the Pubmed, Embase and Cochrane databases, with an additional reference check in the Scopus database. Studies that examined cortical changes on MRI within patients as well as between treated and non-treated patients were included. The quality of the studies was assessed with a checklist specially designed for this review. No meta-analysis was performed due to the lack of randomised trials. Out of 1915 publications twenty-one papers were selected, of which fifteen observed cortical changes after radiation therapy. Two papers reported radiation-dependent decrease in cortical thickness within patients one year after radiation treatment, suggesting a clear relation between the two. However, study quality was considered mostly suboptimal, and there was great inhomogeneity between the included studies. This means that, although there has been increasing interest in the effects of radiation treatment on cortex morphology, no reliable conclusion can be drawn based on the currently available evidence. This calls for more research, preferably with a sufficiently large patient population, and adequate methodology.
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Affiliation(s)
- Steven H J Nagtegaal
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands.
| | - Szabolcs David
- Image Sciences Institute, University Medical Center, Utrecht, the Netherlands.
| | | | - Alexander Leemans
- Image Sciences Institute, University Medical Center, Utrecht, the Netherlands.
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands.
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9
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Dilmanian FA, Krishnan S, McLaughlin WE, Lukaniec B, Baker JT, Ailawadi S, Hirsch KN, Cattell RF, Roy R, Helfer J, Kruger K, Spuhler K, He Y, Tailor R, Vassantachart A, Heaney DC, Zanzonico P, Gobbert MK, Graf JS, Nassimi JR, Fatemi NN, Schweitzer ME, Bangiyev L, Eley JG. Merging Orthovoltage X-Ray Minibeams spare the proximal tissues while producing a solid beam at the target. Sci Rep 2019; 9:1198. [PMID: 30718607 PMCID: PMC6362296 DOI: 10.1038/s41598-018-37733-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/07/2018] [Indexed: 02/07/2023] Open
Abstract
Conventional radiation therapy of brain tumors often produces cognitive deficits, particularly in children. We investigated the potential efficacy of merging Orthovoltage X-ray Minibeams (OXM). It segments the beam into an array of parallel, thin (~0.3 mm), planar beams, called minibeams, which are known from synchrotron x-ray experiments to spare tissues. Furthermore, the slight divergence of the OXM array make the individual minibeams gradually broaden, thus merging with their neighbors at a given tissue depth to produce a solid beam. In this way the proximal tissues, including the cerebral cortex, can be spared. Here we present experimental results with radiochromic films to characterize the method's dosimetry. Furthermore, we present our Monte Carlo simulation results for physical absorbed dose, and a first-order biologic model to predict tissue tolerance. In particular, a 220-kVp orthovoltage beam provides a 5-fold sharper lateral penumbra than a 6-MV x-ray beam. The method can be implemented in arc-scan, which may include volumetric-modulated arc therapy (VMAT). Finally, OXM's low beam energy makes it ideal for tumor-dose enhancement with contrast agents such as iodine or gold nanoparticles, and its low cost, portability, and small room-shielding requirements make it ideal for use in the low-and-middle-income countries.
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Affiliation(s)
- F Avraham Dilmanian
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Psychiatry, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Department of Biomedical Engineering, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
- Stony Brook Cancer Center, Stony Brook University Hospital, Stony Brook, NY, 11794, USA.
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | | | | | - Jameson T Baker
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Radiation Medicine, Northwell Health Medical Center, Northwell, NY, USA
| | - Sandeep Ailawadi
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Kara N Hirsch
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Renee F Cattell
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Biomedical Engineering, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Rahul Roy
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Joel Helfer
- Precision X-ray Inc., North Branford, CT, 06471, USA
| | - Kurt Kruger
- Precision X-ray Inc., North Branford, CT, 06471, USA
| | - Karl Spuhler
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Yulun He
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ramesh Tailor
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Dakota C Heaney
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Pat Zanzonico
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthias K Gobbert
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, 21250, USA
| | - Jonathan S Graf
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, 21250, USA
| | - Jessica R Nassimi
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Nasrin N Fatemi
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
- Department of Radiology, City of Hope, Duarte, CA, 91010, USA
| | - Mark E Schweitzer
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Lev Bangiyev
- Department of Radiology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - John G Eley
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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10
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Othman R, Abdullah KG. Serial MRI Scan of Posterior Fossa Tumours Predict Patients at Risk of Developing Neurocognitive Impairment. Asian Pac J Cancer Prev 2017; 18:1729-1735. [PMID: 28748803 PMCID: PMC5648372 DOI: 10.22034/apjcp.2017.18.7.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Brain tumours are the most common solid tumours in children. More than 50% of these tumours develop in the posterior cranial fossa. Long term survivors of posterior fossa tumours (PFT) suffer from neurocognitive and memory issues. We hypothesized that serial MRI scanning of brain would show differences in hippocampal and ACC volume change in PFT patients treated with and without chemo-radiotherapy. Material and Methods: Twelve patients (8 females and 4 males) underwent 76 serial MR imaging examinations before and during treatment for posterior fossa tumours. Seven patients (4 medulloblastoma, 2 as ependymoma and 1 high grade glioma) were treated with maximum surgical resection followed by adjuvant radiotherapy and chemotherapy (Group 1). The other five patients were diagnosed as pilocytic astrocytoma who were treated only with surgery (Group 2). Hippocampal volumes were obtained manually on high-resolution 3Tesla T1-weighted images and normalised to intracranial volume, while ACC thickness and volume were obtained automatically using FreeSurfer software. Results: After the treatment period, the change in normalised hippocampal volume from baseline was significantly lower in group 1 patients compared to group 2 (mean change -0.0001470 ± 8.981e-005; Mean ± SEM vs 0.0002765 ± 9.151e-005; Mean ± SEM, respectively, P=0.004). Displayed graphically, the negative hippocampal growth trajectory in group 1 gradually returned to a positive growth pattern. There were no statistically significant changes in ACC volume and thickness. Both groups had similar rates of pre-operative hydrocephalus. Conclusion: Compared to PFT patients treated with surgery alone, PFT patients treated with chemo-radiotherapy showed lower hippocampal volumes and altered hippocampal growth trajectory. Serial quantitative MRI measures of brain may provide a neuroanatomical substrate for assessing functional impact on normal brain function following treatment of posterior fossa tumours.
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Affiliation(s)
- Ramadhan Othman
- Department of Internal Medicine, College of medicine, University of Duhok, Duhok, Iraq.
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11
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Neuroimaging in Sepsis: Panacea or Pandora's Box? Pediatr Crit Care Med 2017; 18:716-717. [PMID: 28691959 DOI: 10.1097/pcc.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Kundu P, Li MD, Durkee BY, Hiniker SM, Bush K, von Eyben R, Monje ML, Yeom KW, Donaldson SS, Gibbs IC. Chemoradiation impairs normal developmental cortical thinning in medulloblastoma. J Neurooncol 2017; 133:429-434. [PMID: 28534154 DOI: 10.1007/s11060-017-2453-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 04/27/2017] [Indexed: 11/24/2022]
Abstract
Medulloblastoma patients are treated with surgery, radiation and chemotherapy. Radiation dose to the temporal lobe may be associated with neurocognitive sequelae. Longitudinal changes of temporal lobe cortical thickness may result from neurodevelopmental processes such as synaptic pruning. This study applies longitudinal image analysis to compare developmental change in cortical thickness in medulloblastoma (MB) patients who were treated by combined modality therapy to that of cerebellar juvenile pilocytic astrocytoma (JPA) patients who were treated by surgery alone. We hypothesized that the rates of developmental change in cortical thickness would differ between these two groups. This retrospective cohort study assessed changes in cortical thickness over time between MB and JPA patients. High-resolution magnetic resonance (MR) images of 14 MB and 7 JPA subjects were processed to measure cortical thickness of bilateral temporal lobe substructures. A linear mixed effects model was used to identify differences in substructure longitudinal changes in cortical thickness. The left temporal lobe exhibited overall increased cortical thickness in MB patients relative to JPA patients who showed overall cortical thinning (mean annual cortical thickness change: MB 0.14 mm/year versus JPA -0.018 mm/year across all substructures), particularly in the inferior temporal lobe substructures (p < 0.0001). The cortical thickness change of the right temporal lobe substructures exhibited similar, though attenuated trends (p = 0.002). MB patients exhibit overall increased cortical thickness rather than cortical thinning as seen in JPA patients and as expected in normal cortical development. These observations are possibly due to chemoradiation induced-disruption of normal neuronal mechanisms. Longitudinal image analysis may identify early biomarkers for neurocognitive function with routine imaging.
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Affiliation(s)
- Palak Kundu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew D Li
- Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ben Y Durkee
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl Bush
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michelle L Monje
- Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristen W Yeom
- Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
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13
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Seibert TM, Karunamuni R, Kaifi S, Burkeen J, Connor M, Krishnan AP, White NS, Farid N, Bartsch H, Murzin V, Nguyen TT, Moiseenko V, Brewer JB, McDonald CR, Dale AM, Hattangadi-Gluth JA. Cerebral Cortex Regions Selectively Vulnerable to Radiation Dose-Dependent Atrophy. Int J Radiat Oncol Biol Phys 2017; 97:910-918. [PMID: 28333012 PMCID: PMC5403140 DOI: 10.1016/j.ijrobp.2017.01.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/08/2016] [Accepted: 01/01/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE AND OBJECTIVES Neurologic deficits after brain radiation therapy (RT) typically involve decline in higher-order cognitive functions such as attention and memory rather than sensory defects or paralysis. We sought to determine whether areas of the cortex critical to cognition are selectively vulnerable to radiation dose-dependent atrophy. METHODS AND MATERIALS We measured change in cortical thickness in 54 primary brain tumor patients who underwent fractionated, partial brain RT. The study patients underwent high-resolution, volumetric magnetic resonance imaging (T1-weighted; T2 fluid-attenuated inversion recovery, FLAIR) before RT and 1 year afterward. Semiautomated software was used to segment anatomic regions of the cerebral cortex for each patient. Cortical thickness was measured for each region before RT and 1 year afterward. Two higher-order cortical regions of interest (ROIs) were tested for association between radiation dose and cortical thinning: entorhinal (memory) and inferior parietal (attention/memory). For comparison, 2 primary cortex ROIs were also tested: pericalcarine (vision) and paracentral lobule (somatosensory/motor). Linear mixed-effects analyses were used to test all other cortical regions for significant radiation dose-dependent thickness change. Statistical significance was set at α = 0.05 using 2-tailed tests. RESULTS Cortical atrophy was significantly associated with radiation dose in the entorhinal (P=.01) and inferior parietal ROIs (P=.02). By contrast, no significant radiation dose-dependent effect was found in the primary cortex ROIs (pericalcarine and paracentral lobule). In the whole-cortex analysis, 9 regions showed significant radiation dose-dependent atrophy, including areas responsible for memory, attention, and executive function (P≤.002). CONCLUSIONS Areas of cerebral cortex important for higher-order cognition may be most vulnerable to radiation-related atrophy. This is consistent with clinical observations that brain radiation patients experience deficits in domains of memory, executive function, and attention. Correlations of regional cortical atrophy with domain-specific cognitive functioning in prospective trials are warranted.
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Affiliation(s)
- Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Samar Kaifi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Jeffrey Burkeen
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Michael Connor
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | | | - Nathan S White
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Nikdokht Farid
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Hauke Bartsch
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Vyacheslav Murzin
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Tanya T Nguyen
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - James B Brewer
- Department of Radiology, University of California, San Diego, La Jolla, California; Department of Neurosciences, University of California, San Diego, La Jolla, California
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California; Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, California; Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Neurosciences, University of California, San Diego, La Jolla, California
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.
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14
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Proton therapy for paediatric CNS tumours — improving treatment-related outcomes. Nat Rev Neurol 2016; 12:334-45. [DOI: 10.1038/nrneurol.2016.70] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Roddy E, Mueller S. Late Effects of Treatment of Pediatric Central Nervous System Tumors. J Child Neurol 2016; 31:237-54. [PMID: 26045296 DOI: 10.1177/0883073815587944] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/21/2015] [Indexed: 12/18/2022]
Abstract
Central nervous system tumors represent the most common solid malignancy in childhood. Improvement in treatment approaches have led to a significant increase in survival rates, with over 70% of children now surviving beyond 5 years. As more and more children with CNS tumors have longer survival times, it is important to be aware of the long-term morbidities caused not only by the tumor itself but also by tumor treatment. The most common side effects including poor neurocognition, endocrine dysfunction, neurological and vascular late effects, as well as secondary malignancies, are discussed within this article.
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Affiliation(s)
- Erika Roddy
- School of Medicine, University of California, San Francisco, CA, USA
| | - Sabine Mueller
- Department of Neurology, University of California, San Francisco, CA, USA Department of Pediatrics, University of California, San Francisco, CA, USA Department of Neurosurgery, University of California, San Francisco, CA, USA
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16
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Karunamuni R, Bartsch H, White NS, Moiseenko V, Carmona R, Marshall DC, Seibert TM, McDonald CR, Farid N, Krishnan A, Kuperman J, Mell L, Brewer JB, Dale AM, Hattangadi-Gluth JA. Dose-Dependent Cortical Thinning After Partial Brain Irradiation in High-Grade Glioma. Int J Radiat Oncol Biol Phys 2016; 94:297-304. [PMID: 26853338 PMCID: PMC4747044 DOI: 10.1016/j.ijrobp.2015.10.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/28/2015] [Accepted: 10/13/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE Radiation-induced cognitive deficits may be mediated by tissue damage to cortical regions. Volumetric changes in cortex can be reliably measured using high-resolution magnetic resonance imaging (MRI). We used these methods to study the association between radiation therapy (RT) dose and change in cortical thickness in high-grade glioma (HGG) patients. METHODS AND MATERIALS We performed a voxel-wise analysis of MRI from 15 HGG patients who underwent fractionated partial brain RT. Three-dimensional MRI was acquired pre- and 1 year post RT. Cortex was parceled with well-validated segmentation software. Surgical cavities were censored. Each cortical voxel was assigned a change in cortical thickness between time points, RT dose value, and neuroanatomic label by lobe. Effects of dose, neuroanatomic location, age, and chemotherapy on cortical thickness were tested using linear mixed effects (LME) modeling. RESULTS Cortical atrophy was seen after 1 year post RT with greater effects at higher doses. Estimates from LME modeling showed that cortical thickness decreased by -0.0033 mm (P<.001) for every 1-Gy increase in RT dose. Temporal and limbic cortex exhibited the largest changes in cortical thickness per Gy compared to that in other regions (P<.001). Age and chemotherapy were not significantly associated with change in cortical thickness. CONCLUSIONS We found dose-dependent thinning of the cerebral cortex, with varying neuroanatomical regional sensitivity, 1 year after fractionated partial brain RT. The magnitude of thinning parallels 1-year atrophy rates seen in neurodegenerative diseases and may contribute to cognitive decline following high-dose RT.
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Affiliation(s)
- Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Hauke Bartsch
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Nathan S White
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Ruben Carmona
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Deborah C Marshall
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Carrie R McDonald
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Nikdokht Farid
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Anithapriya Krishnan
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Joshua Kuperman
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Loren Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - James B Brewer
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Anders M Dale
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
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Nieman BJ, de Guzman AE, Gazdzinski LM, Lerch JP, Chakravarty MM, Pipitone J, Strother D, Fryer C, Bouffet E, Laughlin S, Laperriere N, Riggs L, Skocic J, Mabbott DJ. White and Gray Matter Abnormalities After Cranial Radiation in Children and Mice. Int J Radiat Oncol Biol Phys 2015; 93:882-91. [DOI: 10.1016/j.ijrobp.2015.07.2293] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
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18
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Effects of Cranial Radiation on Structural and Functional Brain Development in Pediatric Brain Tumors. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2015. [DOI: 10.1007/s40817-015-0008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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de Guzman AE, Gazdzinski LM, Alsop RJ, Stewart JM, Jaffray DA, Wong CS, Nieman BJ. Treatment Age, Dose and Sex Determine Neuroanatomical Outcome in Irradiated Juvenile Mice. Radiat Res 2015; 183:541-9. [DOI: 10.1667/rr13854.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Lisa M. Gazdzinski
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Richard J. Alsop
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M. Stewart
- Radiation Medicine Program and Techna Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David A. Jaffray
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - C. Shun Wong
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Brian J. Nieman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
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20
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Fuentes D, Contreras J, Yu J, He R, Castillo E, Castillo R, Guerrero T. Morphometry-based measurements of the structural response to whole-brain radiation. Int J Comput Assist Radiol Surg 2014; 10:393-401. [PMID: 25408306 DOI: 10.1007/s11548-014-1128-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Morphometry techniques were applied to quantify the normal tissue therapy response in patients receiving whole-brain radiation for intracranial malignancies. METHODS Pre- and Post-irradiation magnetic resonance imaging (MRI) data sets were retrospectively analyzed in N = 15 patients. Volume changes with respect to pre-irradiation were quantitatively measured in the cerebrum and ventricles. Measurements were correlated with the time interval from irradiation. Criteria for inclusion included craniospinal irradiation, pre-irradiation MRI, at least one follow-up MRI, and no disease progression. The brain on each image was segmented to remove the skull and registered to the initial pre-treatment scan. Average volume changes were measured using morphometry analysis of the deformation Jacobian and direct template registration-based segmentation of brain structures. RESULTS An average cerebral volume atrophy of -0.2 and -3% 3% was measured for the deformation morphometry and direct segmentation methods, respectively. An average ventricle volume dilation of 21 and 20% was measured for the deformation morphometry and direct segmentation methods, respectively. CONCLUSION The presented study has developed an image processing pipeline for morphometric monitoring of brain tissue volume changes as a response to radiation therapy. Results indicate that quantitative morphometric monitoring is feasible and may provide additional information in assessing response.
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Affiliation(s)
- D Fuentes
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA,
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21
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Gamma deficits as a neural signature of cognitive impairment in children treated for brain tumors. J Neurosci 2014; 34:8813-24. [PMID: 24966381 DOI: 10.1523/jneurosci.5220-13.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cognitive impairment is consistently reported in children treated for brain tumors, particularly in the categories of processing speed, memory, and attention. Although tumor site, hydrocephalus, chemotherapy, and cranial radiation therapy (CRT) are all associated with poorer function, CRT predicts the greatest deficits. There is a particularly high correlation between CRT and slowed information-processing speed. Cortical gamma-band oscillations have been associated with processing behaviorally relevant information; however, their role in the maintenance of cognition in individuals with processing deficits is unclear. We examined gamma oscillations using magnetoencephalography (MEG) in children undergoing CRT to test whether gamma characteristics can be a signature of cognitive impairment in this population. We collected resting-state data as well as data from baseline and active periods during two visual-motor reaction time tasks of varying cognitive loads from 18 healthy children and 20 patients. We found that only high-gamma oscillations (60-100 Hz), and not low-gamma oscillations (30-59 Hz), showed significant group differences in absolute power levels. Overall, compared with healthy children, patients showed the following: (1) lower total high-gamma (60-100 Hz) power during the resting state, as well as during task-related baseline and performance measures; (2) no change in gamma reactivity to increases in cognitive load; and (3) slower processing speeds both inside and outside MEG. Our findings show that high-gamma oscillations are disrupted in children after treatment for a brain tumor. The temporal dynamic of the high-gamma response during information processing may index cognitive impairment in humans with neurological injury.
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22
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Hoang DH, Pagnier A, Guichardet K, Dubois-Teklali F, Schiff I, Lyard G, Cousin E, Krainik A. Cognitive disorders in pediatric medulloblastoma: what neuroimaging has to offer. J Neurosurg Pediatr 2014; 14:136-44. [PMID: 24950472 DOI: 10.3171/2014.5.peds13571] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Medulloblastomas are the most common malignant childhood brain tumors arising in the posterior fossa. Treatment improvements for these tumors have meant that there are a greater number of survivors, but this long-term patient survival has increased the awareness of resulting neurocognitive deficits. Impairments in attention, memory, executive functions, and intelligence quotient demonstrate that the cerebellum likely plays a significant role in numerous higher cognitive functions such as language, cognitive, and emotional functions. In addition, children with medulloblastoma not only have cerebellar lesions but also brain white matter damages due to radiation and chemotherapy. Functional neuroimaging, a noninvasive method with many advantages, has become the standard tool in clinical and cognitive neuroscience research. By reviewing functional neuroimaging studies, this review aims to clarify the role of the cerebellum in cognitive function and explain more clearly cognitive sequelae due to polytherapy in children with medulloblastoma. This review suggests that the posterior cerebellar lobes are crucial to maintaining cognitive performance. Clinical investigations could help to better assess the involvement of these lobes in cognitive functions.
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Affiliation(s)
- Duc Ha Hoang
- Department of Radiology, University Hospital Viettiep, Haiphong, Vietnam
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23
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Muzumdar D, Ventureyra ECG. Treatment of posterior fossa tumors in children. Expert Rev Neurother 2014; 10:525-46. [DOI: 10.1586/ern.10.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Padovani L, André N, Constine LS, Muracciole X. Neurocognitive function after radiotherapy for paediatric brain tumours. Nat Rev Neurol 2012; 8:578-88. [DOI: 10.1038/nrneurol.2012.182] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Adult medulloblastoma: multiagent chemotherapy with cisplatinum and etoposide: a single institutional experience. J Neurooncol 2011; 106:595-600. [PMID: 21874383 DOI: 10.1007/s11060-011-0696-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
Abstract
In 1991, a prospective phase II trial was initiated to evaluate the efficacy of treatment for adults with medulloblastoma (MB). After surgery, patients were staged with a neuroradiologic examination of the brain and neuroaxis and by cerebrospinal fluid cytology. All patients received three cycles of upfront cisplatinum (cisplatinum) and etoposide (VP16) chemotherapy followed by cranio-spinal radiation therapy. The current article reports on the long-term results from that trial. After a median follow-up of 14.9 years, among a total of 28 adults with MB, the overall progression-free survival and overall survival (OS) rates at 5 years were 57.6 and 80%, respectively. The median OS for the whole group of patients was 11.3 years. The observed toxicity was mainly hematological, with leukopenia and thrombocytopenia (16% of grades 3 and 4). In summary, in our small series of patients, the role of combination administration of CDDP + VP16 started before the initiation of radiotherapy in reducing recurrences, particularly distant recurrences, remains unclear. To know whether adding chemotherapy to craniospinal radiation in adult therapy increases relapse-free and overall survival, we must await the results of a larger randomized controlled clinical trial.
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Intermediate templates guided groupwise registration of diffusion tensor images. Neuroimage 2010; 54:928-39. [PMID: 20851197 DOI: 10.1016/j.neuroimage.2010.09.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/03/2010] [Accepted: 09/08/2010] [Indexed: 11/21/2022] Open
Abstract
Registration of a population of diffusion tensor images (DTIs) is one of the key steps in medical image analysis, and it plays an important role in the statistical analysis of white matter related neurological diseases. However, pairwise registration with respect to a pre-selected template may not give precise results if the selected template deviates significantly from the distribution of images. To cater for more accurate and consistent registration, a novel framework is proposed for groupwise registration with the guidance from one or more intermediate templates determined from the population of images. Specifically, we first use a Euclidean distance, defined as a combinative measure based on the FA map and ADC map, for gauging the similarity of each pair of DTIs. A fully connected graph is then built with each node denoting an image and each edge denoting the distance between a pair of images. The root template image is determined automatically as the image with the overall shortest path length to all other images on the minimum spanning tree (MST) of the graph. Finally, a sequence of registration steps is applied to progressively warping each image towards the root template image with the help of intermediate templates distributed along its path to the root node on the MST. Extensive experimental results using diffusion tensor images of real subjects indicate that registration accuracy and fiber tract alignment are significantly improved, compared with the direct registration from each image to the root template image.
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27
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Little AS, Liu S, Beeman S, Sankar T, Preul MC, Hu LS, Smith KA, Baxter LC. Brain Retraction and Thickness of Cerebral Neocortex: An Automated Technique for Detecting Retraction-Induced Anatomic Changes Using Magnetic Resonance Imaging. Oper Neurosurg (Hagerstown) 2010; 67:ons277-82; discussion ons282. [DOI: 10.1227/01.neu.0000374699.12150.0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Treating deep-seated cerebral lesions often requires retracting the brain. Retraction, however, causes clinically significant postoperative neurological deficits in 3% to 9% of intracranial cases.
OBJECTIVE:
This pilot study used automated analysis of postoperative magnetic resonance images (MRIs) to determine whether brain retraction caused local anatomic changes to the cerebral neocortex and whether such changes represented sensitive markers for detecting brain retraction injury.
METHODS:
Pre- and postoperative maps of whole-brain cortical thickness were generated from 3-dimensional MRIs of 6 patients who underwent selective amygdalohippocam-pectomy for temporal lobe epilepsy (5 left hemispheres, 1 right hemisphere). Mean cortical thickness was determined in the inferior temporal gyrus (ITG test), where a retractor was placed during surgery, and in 2 control gyri—the posterior portion of the inferior temporal gyrus (ITG control) and motor cortex control. Regions of cortical thinning were also compared with signs of retraction injury on early postoperative MRIs.
RESULTS:
Postoperative maps of cortical thickness showed thinning in the inferior temporal gyrus where the retractor was placed in 5 patients. Postoperatively, mean cortical thickness declined from 4.1 ± 0.4 mm to 2.9 ± 0.9 mm in ITG test (P = .03) and was unchanged in the control regions. Anatomically, the region of neocortical thinning correlated with postoperative edema on MRIs obtained within 48 hours of surgery.
CONCLUSION:
Postoperative MRIs can be successfully interrogated for information on cortical thickness. Brain retraction is associated with chronic local thinning of the neocortex. This automated technique may be sensitive enough to detect regions at risk for functional impairment during craniotomy that cannot be easily detected on postoperative structural imaging.
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Affiliation(s)
- Andrew S. Little
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Seban Liu
- Division of Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Scott Beeman
- Division of Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Tejas Sankar
- Neurosurgery Research Laboratory, Division of Neurological Surgery Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Neurosurgery Research Laboratory, Division of Neurological Surgery Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Leland S. Hu
- Adjunct, Division of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Kris A. Smith
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Leslie C. Baxter
- Division of Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Horská A, Laclair A, Mohamed M, Wells CT, McNutt T, Cohen KJ, Wharam M, Mahone EM, Kates W. Low cerebellar vermis volumes and impaired neuropsychologic performance in children treated for brain tumors and leukemia. AJNR Am J Neuroradiol 2010; 31:1430-7. [PMID: 20448013 DOI: 10.3174/ajnr.a2114] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Injury of the cerebellar vermis may occur in children with brain malignancies. Because the vermis is involved in motor and cognitive functioning, the goal of this prospective longitudinal study was to evaluate treatment-related changes in vermal volumes and neuropsychologic performance in children receiving brain radiation of the cerebellum. MATERIALS AND METHODS Ten patients (mean age, 11.6 years) and 10 healthy children (mean age, 12.1 years) were examined. Lobar vermal volumes and performance on neuropsychologic tests evaluating motor, visual, verbal, attention, memory, and executive functions were assessed at baseline and at 6-month follow-up visits. RESULTS At baseline, lower mean vermal volumes and impaired performance on visual-spatial and fine-motor tasks were detected in patients. At 6-month follow-up, further decrease in vermal volumes was detected only in patients with medulloblastoma, who received the largest radiation doses to the entire vermis. The volume decrease was not associated with reduction in neuropsychologic performance compared with baseline. At 6-month follow-up, data from all subjects revealed an association between smaller vermal volumes and slower fine-motor speed and lower visual-spatial skills. CONCLUSIONS Reduced brain-tissue volumes following radiation have been reported previously in pediatric patients. In this study, lower vermal volumes were detected even earlier, before radiation treatment was initiated or completed. Six months postradiation, vermal volume decreases detected in patients with medulloblastoma were not accompanied by declines in already poor neuropsychologic performance. In addition to radiation, the presence of brain malignancies and preradiation treatment may be important factors affecting cerebellar vermis tissue.
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Affiliation(s)
- A Horská
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore,MD, USA.
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29
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Fossati P, Ricardi U, Orecchia R. Pediatric medulloblastoma: toxicity of current treatment and potential role of protontherapy. Cancer Treat Rev 2008; 35:79-96. [PMID: 18976866 DOI: 10.1016/j.ctrv.2008.09.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/30/2008] [Accepted: 09/03/2008] [Indexed: 11/25/2022]
Abstract
Post-operative craniospinal irradiation and systemic chemotherapy are both necessary in the treatment of pediatric medulloblastoma. Late toxicity is a major problem in long term survivors and significantly affects their quality of life. We have systematically reviewed the literature to examine data on late toxicity, specifically focusing on: endocrine function, growth and bone development, neurocognitive development, second cancers, ototoxicity, gynecological toxicity and health of the offspring, cardiac toxicity and pulmonary toxicity. In this paper, we describe qualitatively the kind of detected side effects and, whenever possible, try to assess their incidence and the relative role of craniospinal irradiation (as opposed to other treatments and to the disease itself) in producing them. Subsequently we examine the possible approach to reduce unwanted effects from craniospinal irradiation to target and non-target tissues and we consider briefly the role of hyperfractionation, tomotherapy and IMRT. We describe the characteristics of protontherapy and its potential for non-target tissues toxicity reduction reviewing the existing physical and dosimetric studies and the (still very limited) clinical experiences. Finally we propose intensity modulated spot scanning protontherapy with multiportal simultaneous optimization (IMPT) as a possible tool for dose distribution optimization within different areas of CNS and potential reduction of target tissues toxicity.
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Affiliation(s)
- Piero Fossati
- Institute of Radiological Sciences, University of Milan, Milano, Italy.
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30
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Abstract
Central nervous system (CNS) tumors are the most common solid neoplasms in childhood and the second most common malignancies after leukemia in the pediatric age group. Supratentorial tumors are more common in children younger than 2 years old and in adolescents, whereas in patients between 2 and 12 years of age brain tumors originating in the posterior fossa dominate. This implies a relationship between the type of tumor, its location and the age of the patient, which has to be considered in differential diagnoses. Medulloblastoma represents the most common malignant brain tumor in childhood. In the posterior fossa medulloblastomas are approximately as frequent as astrocytomas. Supratentorial astrocytomas are by far the main tumor type. In this report some typical CNS neoplasms in children are discussed and their neuroradiological features are demonstrated.
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Affiliation(s)
- M Sinzig
- Kinderradiologie RZI , Landeskrankenhaus Klagenfurt, Klagenfurt, Osterreich.
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31
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Vaquero E, Gómez CM, Quintero EA, González-Rosa JJ, Márquez J. Differential prefrontal-like deficit in children after cerebellar astrocytoma and medulloblastoma tumor. Behav Brain Funct 2008; 4:18. [PMID: 18412947 PMCID: PMC2362115 DOI: 10.1186/1744-9081-4-18] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 04/15/2008] [Indexed: 12/22/2022] Open
Abstract
Background This study was realized thanks to the collaboration of children and adolescents who had been resected from cerebellar tumors. The medulloblastoma group (CE+, n = 7) in addition to surgery received radiation and chemotherapy. The astrocytoma group (CE, n = 13) did not receive additional treatments. Each clinical group was compared in their executive functioning with a paired control group (n = 12). The performances of the clinical groups with respect to controls were compared considering the tumor's localization (vermis or hemisphere) and the affectation (or not) of the dentate nucleus. Executive variables were correlated with the age at surgery, the time between surgery-evaluation and the resected volume. Methods The executive functioning was assessed by means of WCST, Complex Rey Figure, Controlled Oral Word Association Test (letter and animal categories), Digits span (WISC-R verbal scale) and Stroop test. These tests are very sensitive to dorsolateral PFC and/or to medial frontal cortex functions. The scores for the non-verbal Raven IQ were also obtained. Direct scores were corrected by age and transformed in standard scores using normative data. The neuropsychological evaluation was made at 3.25 (SD = 2.74) years from surgery in CE group and at 6.47 (SD = 2.77) in CE+ group. Results The Medulloblastoma group showed severe executive deficit (≤ 1.5 SD below normal mean) in all assessed tests, the most severe occurring in vermal patients. The Astrocytoma group also showed executive deficits in digits span, semantic fluency (animal category) and moderate to slight deficit in Stroop (word and colour) tests. In the astrocytoma group, the tumor's localization and dentate affectation showed different profile and level of impairment: moderate to slight for vermal and hemispheric patients respectively. The resected volume, age at surgery and the time between surgery-evaluation correlated with some neuropsychological executive variables. Conclusion Results suggest a differential prefrontal-like deficit due to cerebellar lesions and/or cerebellar-frontal diaschisis, as indicate the results in astrocytoma group (without treatments), that also can be generated and/or increased by treatments in the medulloblastoma group. The need for differential rehabilitation strategies for specific clinical groups is remarked. The results are also discussed in the context of the Cerebellar Cognitive Affective Syndrome.
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Affiliation(s)
- Encarna Vaquero
- Department of Experimental Psychology, Seville University, Seville, Spain.
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32
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Young K, Schuff N. Measuring structural complexity in brain images. Neuroimage 2007; 39:1721-30. [PMID: 18158255 DOI: 10.1016/j.neuroimage.2007.10.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 09/14/2007] [Accepted: 10/24/2007] [Indexed: 11/28/2022] Open
Abstract
An information theory based formalism for medical image analysis proposed in Young et al. [Young, K., Chen, Y., Kornak, J., Matson G. B., Schuff, N., 2005. Summarizing Complexity in High Dimensions, Phys. Rev. Lett. 94 098701-1] is described and used to estimate image complexity measures as a means of generating interpretable summary information. An analysis of anatomical brain MRI data exhibiting cortical thinning, currently considered to be a sensitive early biomarker for neurodegenerative diseases, is used to illustrate the method. Though requiring no previous assumptions about the detailed shape of the cortex or other brain structures, the method performed comparably (sensitivity=0.91) to direct cortical thickness estimation techniques (sensitivity=0.93) at separating populations in a data set designed specifically to test the cortical thickness estimation algorithms. The results illustrate that the complexity estimation method, though general, is capable of providing interpretable diagnostic information.
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Affiliation(s)
- Karl Young
- Department of Radiology, University of California San Francisco and Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
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