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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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Schmidt S, Kovacs E, Usta D, Behnisch R, Sahm F, Haux D, Witt O, Milde T, Unterberg A, El Damaty A. Cerebellar Mutism Syndrome After Posterior Fossa Tumor Surgery in Children-A Retrospective Single-Center Study. World Neurosurg 2023; 173:e622-e628. [PMID: 36871657 DOI: 10.1016/j.wneu.2023.02.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Cerebellar mutism syndrome (CMS) is a well-known complication after posterior fossa tumor surgery in pediatric patients. We evaluated the incidence of CMS in our institute and analyzed its association with multiple risk factors, such as tumor entity, surgical approach, and hydrocephalus. METHODS All pediatric patients who had undergone intra-axial tumor resection in the posterior fossa between January 2010 and March 2021 were included in the retrospective analysis. Various data points, including demographic, tumor-associated, clinical, radiological, surgery-associated, complications, and follow-up data, were collected and statistically evaluated for an association with CMS. RESULTS A total of 63 surgeries in 60 patients were included. The median patient age was 8 years. Pilocytic astrocytoma was the most common tumor type (50%), followed by medulloblastoma (28%) and ependymomas (10%). Complete, subtotal, and partial resection was achieved in 67%, 23%, and 10%, respectively. A telovelar approach had been used the most often (43%) compared with a transvermian approach (8%). Of the 60 children, 10 (17%) had developed CMS and showed marked improvement but with residual deficits. The significant risk factors were a transvermian approach (P = 0.03), vermian splitting when added to another approach (P = 0.002), an initial presentation with acute hydrocephalus (P = 0.02), and hydrocephalus present after tumor surgery (P = 0.004). CONCLUSIONS Our CMS rate is comparable to those described in the literature. Despite the limitations of the retrospective study design, we found that CMS was not only associated with a transvermian approach but was also associated with a telovelar approach, although to a lesser extent. Acute hydrocephalus at the initial presentation necessitating urgent management was significantly associated with a greater incidence of CMS.
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Affiliation(s)
- Stephanie Schmidt
- Neurosurgery Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Edina Kovacs
- Neurosurgery Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Diren Usta
- Pediatric Neurooncology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Rouven Behnisch
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany; CCU Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - Daniel Haux
- Neurosurgery Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Olaf Witt
- Pediatric Neurooncology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Milde
- Pediatric Neurooncology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Unterberg
- Neurosurgery Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Ahmed El Damaty
- Neurosurgery Department, Heidelberg University Hospital, Heidelberg, Germany.
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Toescu SM, Bruckert L, Jabarkheel R, Yecies D, Zhang M, Clark CA, Mankad K, Aquilina K, Grant GA, Feldman HM, Travis KE, Yeom KW. Spatiotemporal changes in along-tract profilometry of cerebellar peduncles in cerebellar mutism syndrome. Neuroimage Clin 2022; 35:103000. [PMID: 35370121 PMCID: PMC9421471 DOI: 10.1016/j.nicl.2022.103000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/16/2022] [Accepted: 03/28/2022] [Indexed: 10/29/2022]
Abstract
Cerebellar mutism syndrome, characterised by mutism, emotional lability and cerebellar motor signs, occurs in up to 39% of children following resection of medulloblastoma, the most common malignant posterior fossa tumour of childhood. Its pathophysiology remains unclear, but prior studies have implicated damage to the superior cerebellar peduncles. In this study, the objective was to conduct high-resolution spatial profilometry of the cerebellar peduncles and identify anatomic biomarkers of cerebellar mutism syndrome. In this retrospective study, twenty-eight children with medulloblastoma (mean age 8.8 ± 3.8 years) underwent diffusion MRI at four timepoints over one year. Forty-nine healthy children (9.0 ± 4.2 years), scanned at a single timepoint, served as age- and sex-matched controls. Automated Fibre Quantification was used to segment cerebellar peduncles and compute fractional anisotropy (FA) at 30 nodes along each tract. Thirteen patients developed cerebellar mutism syndrome. FA was significantly lower in the distal third of the left superior cerebellar peduncle pre-operatively in all patients compared to controls (FA in proximal third 0.228, middle and distal thirds 0.270, p = 0.01, Cohen's d = 0.927). Pre-operative differences in FA did not predict cerebellar mutism syndrome. However, post-operative reductions in FA were highly specific to the distal left superior cerebellar peduncle, and were most pronounced in children with cerebellar mutism syndrome compared to those without at the 1-4 month follow up (0.325 vs 0.512, p = 0.042, d = 1.36) and at the 1-year follow up (0.342, vs 0.484, p = 0.038, d = 1.12). High spatial resolution cerebellar profilometry indicated a site-specific alteration of the distal segment of the superior cerebellar peduncle seen in cerebellar mutism syndrome which may have important surgical implications in the treatment of these devastating tumours of childhood.
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Affiliation(s)
- Sebastian M Toescu
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA; Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK; Department of Neurosurgery, Great Ormond Street Hospital, London WC1N 3JH, UK.
| | - Lisa Bruckert
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rashad Jabarkheel
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Derek Yecies
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Zhang
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Christopher A Clark
- Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Gerald A Grant
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Heidi M Feldman
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Katherine E Travis
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
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Toescu SM, Hales PW, Kaden E, Lacerda LM, Aquilina K, Clark CA. Tractographic and Microstructural Analysis of the Dentato-Rubro-Thalamo-Cortical Tracts in Children Using Diffusion MRI. Cereb Cortex 2021; 31:2595-2609. [PMID: 33338201 DOI: 10.1093/cercor/bhaa377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The dentato-rubro-thalamo-cortical tract (DRTC) is the main outflow pathway of the cerebellum, contributing to a finely balanced corticocerebellar loop involved in cognitive and sensorimotor functions. Damage to the DRTC has been implicated in cerebellar mutism syndrome seen in up to 25% of children after cerebellar tumor resection. Multi-shell diffusion MRI (dMRI) combined with quantitative constrained spherical deconvolution tractography and multi-compartment spherical mean technique modeling was used to explore the frontocerebellar connections and microstructural signature of the DRTC in 30 healthy children. The highest density of DRTC connections were to the precentral (M1) and superior frontal gyri (F1), and from cerebellar lobules I-IV and IX. The first evidence of a topographic organization of anterograde projections to the frontal cortex at the level of the superior cerebellar peduncle (SCP) is demonstrated, with streamlines terminating in F1 lying dorsomedially in the SCP compared to those terminating in M1. The orientation dispersion entropy of DRTC regions appears to exhibit greater contrast than that shown by fractional anisotropy. Analysis of a separate reproducibility cohort demonstrates good consistency in the dMRI metrics described. These novel anatomical insights into this well-studied pathway may prove to be of clinical relevance in the surgical resection of cerebellar tumors.
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Affiliation(s)
- Sebastian M Toescu
- Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, London WC1N 1EH, UK.,Department of Neurosurgery, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Patrick W Hales
- Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, London WC1N 1EH, UK
| | - Enrico Kaden
- Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, London WC1N 1EH, UK.,Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
| | - Luis M Lacerda
- Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, London WC1N 1EH, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Christopher A Clark
- Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, London WC1N 1EH, UK
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Gomes CA, Steiner KM, Ludolph N, Spisak T, Ernst TM, Mueller O, Göricke SL, Labrenz F, Ilg W, Axmacher N, Timmann D. Resection of cerebellar tumours causes widespread and functionally relevant white matter impairments. Hum Brain Mapp 2021; 42:1641-1656. [PMID: 33410575 PMCID: PMC7978119 DOI: 10.1002/hbm.25317] [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: 10/05/2020] [Accepted: 11/22/2020] [Indexed: 12/14/2022] Open
Abstract
Several diffusion tensor imaging studies reveal that white matter (WM) lesions are common in children suffering from benign cerebellar tumours who are treated with surgery only. The clinical implications of WM alterations that occur as a direct consequence of cerebellar disease have not been thoroughly studied. Here, we analysed structural and diffusion imaging data from cerebellar patients with chronic surgical lesions after resection for benign cerebellar tumours. We aimed to elucidate the impact of focal lesions of the cerebellum on WM integrity across the entire brain, and to investigate whether WM deficits were associated with behavioural impairment in three different motor tasks. Lesion symptom mapping analysis suggested that lesions in critical cerebellar regions were related to deficits in savings during an eyeblink conditioning task, as well as to deficits in motor action timing. Diffusion imaging analysis of cerebellar WM indicated that better behavioural performance was associated with higher fractional anisotropy (FA) in the superior cerebellar peduncle, cerebellum's main outflow path. Moreover, voxel‐wise analysis revealed a global pattern of WM deficits in patients within many cerebral WM tracts critical for motor and non‐motor function. Finally, we observed a positive correlation between FA and savings within cerebello‐thalamo‐cortical pathways in patients but not in controls, showing that saving effects partly depend on extracerebellar areas, and may be recruited for compensation. These results confirm that the cerebellum has extended connections with many cerebral areas involved in motor/cognitive functions, and the observed WM changes likely contribute to long‐term clinical deficits of posterior fossa tumour survivors.
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Affiliation(s)
- Carlos Alexandre Gomes
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Katharina M Steiner
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nicolas Ludolph
- Cognitive Neurology, Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research and Center for Integrative Neuroscience (HIH), Eberhard Karls University, Tübingen, Germany
| | - Tamas Spisak
- Predictive Neuroimaging Lab, Institute for Artificial Intelligence in Medicine - Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Thomas M Ernst
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Oliver Mueller
- Department of Neurosurgery, Klinikum Dortmund, Dortmund, Germany.,Department of Neurosurgery, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Franziska Labrenz
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Winfried Ilg
- Cognitive Neurology, Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research and Center for Integrative Neuroscience (HIH), Eberhard Karls University, Tübingen, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
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Dellatolas G, Câmara-Costa H. The role of cerebellum in the child neuropsychological functioning. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:265-304. [PMID: 32958180 DOI: 10.1016/b978-0-444-64150-2.00023-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This chapter proposes a review of neuropsychologic and behavior findings in pediatric pathologies of the cerebellum, including cerebellar malformations, pediatric ataxias, cerebellar tumors, and other acquired cerebellar injuries during childhood. The chapter also contains reviews of the cerebellar mutism/posterior fossa syndrome, reported cognitive associations with the development of the cerebellum in typically developing children and subjects born preterm, and the role of the cerebellum in neurodevelopmental disorders such as autism spectrum disorders and developmental dyslexia. Cognitive findings in pediatric cerebellar disorders are considered in the context of known cerebellocerebral connections, internal cellular organization of the cerebellum, the idea of a universal cerebellar transform and computational internal models, and the role of the cerebellum in specific cognitive and motor functions, such as working memory, language, timing, or control of eye movements. The chapter closes with a discussion of the strengths and weaknesses of the cognitive affective syndrome as it has been described in children and some conclusions and perspectives.
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Affiliation(s)
- Georges Dellatolas
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France.
| | - Hugo Câmara-Costa
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France; Centre d'Etudes en Santé des Populations, INSERM U1018, Paris, France
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Koiso T, Yamamoto M, Watanabe S, Barfod BE. Signal intensity increases in dentate nucleus/globus pallidus/pulvinar on unenhanced T1WI MR images after multiple examinations with gadodiamide. Neuroradiol J 2019; 32:215-224. [PMID: 30924388 DOI: 10.1177/1971400919839646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Elevated signal intensity (SI) in the dentate nucleus (DN), globus pallidus (GP) and pulvinar (PUL) was reportedly observed on unenhanced T1-weighted (T1WI) magnetic resonance (MR) images in patients receiving multiple enhanced MR examinations. We aimed to clarify whether this phenomenon influences the long-term neurological status of patients. MATERIALS AND METHODS We studied 196 radiosurgically treated patients undergoing ≥10 MR examinations using a single dose of gadodiamide and the same 1.5 Tesla MR unit. SI ratios were calculated by referencing the brainstem (BS) for the DN and the thalamus (TH) for the GP and PUL. We compared the SI ratios at the first, fifth, and 10th, and at the most recent examinations. The neurological symptoms of all 196 patients were assessed at each MR examination by one of the authors (MY). RESULTS The DN/BS and GP/TH SI ratios were significantly increased at the fifth examination ( p < .0001, p = 0.0094) and, thereafter, gradually increased. Although the PUL/TH SI ratio was not significantly increased at the fifth examination ( p = 0.2515), a significant increase was noted at the 10th examination ( p < .0001). There were no significant predictive factors for DN/BS SI increases. Younger age, no brain metastasis, and normal estimated glomerular filtration rate were related to GP/TH SI ratio increases ( p = 0.0308, p = 0.0001, p = 0.0306). Higher age and total bilirubin level were related to an increased PUL/TH SI ratio ( p = 0.0276, p = 0.0097). No patients experienced gadodiamide-related health problems. CONCLUSIONS Although the SI ratios rose as numbers of gadodiamide administrations increased, no adverse health effects have developed to date.
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Affiliation(s)
- Takao Koiso
- 1 Katsuta Hospital Mito GammaHouse, Hitachinaka, Japan.,2 Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masaaki Yamamoto
- 1 Katsuta Hospital Mito GammaHouse, Hitachinaka, Japan.,3 Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Japan
| | - Shinya Watanabe
- 2 Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
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Partanen M, Bouffet E, Laughlin S, Strother D, Hukin J, Skocic J, Szulc-Lerch K, Mabbott DJ. Early changes in white matter predict intellectual outcome in children treated for posterior fossa tumors. NEUROIMAGE-CLINICAL 2018; 20:697-704. [PMID: 30219617 PMCID: PMC6139996 DOI: 10.1016/j.nicl.2018.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Abstract
Purpose Prospective and longitudinal neuroimaging studies of posterior fossa tumors are scarce. Here we evaluate the early changes in white matter and intellectual outcome up to 3 years after diagnosis. Patients and methods Twenty-two children with posterior fossa tumors and 24 similarly-aged healthy children participated. Patients included: (a) 12 individuals who received surgery, cranial-spinal radiation (CSR), and focal radiation to the tumor bed (CSR group) and (b) 10 individuals who received local therapy, either surgery only or surgery and focal radiation to the tumor bed (Local group). Diffusion tensor imaging (DTI) and intelligence measures were obtained an average of 3 months after diagnosis and then at 12, 24, and 36 months later. DTI tractography and voxel-wise approaches were employed. The Neurological Predictor Scale was used to summarize the type and amount of treatment for PF tumor patients. Linear mixed modelling was used to evaluate group differences at baseline and changes over time in DTI metrics for both the specific white matter tracts and voxel-wise, as well as for intelligence measures. Results Based on tractography, patients treated with CSR had significantly higher Axial and Mean diffusivity in the cortical-spinal tracts (CST) 3 month after diagnosis – particularly on the right side, p < .003, compared to healthy children. Mean diffusivity in right CST decreased over time in this group of patients, p = .001. No differences compared to controls were evident in specific tracts for the Local group, p > .10. Voxel-wise analyses revealed multiple areas of white matter compromise in both patients groups. Notably, both patient groups had lower scores on intelligence measures compared to the Control group: The CSR group displayed lower performance 3 months following diagnosis, ps < 0.001, and their performance remained stable over time ps > 0.10, whereas the Local group displayed no differences at 3 months, ps> 0.10, but their performance declined over time, ps < 0.01. At baseline, higher MD in right CST predicted lower Perceptual Reasoning scores across all participants, p = .001. Furthermore, lower FA in left IFOF at baseline predicted decline in Processing Speed over time, p = .001. In patients, more aggressive treatment protocols and presence of mutism were related to lower performance on intelligence measures at baseline, ps < 0.04. Conclusions Children treated with CSR displayed diffuse white matter compromise and poor intellectual outcome shortly after radiation treatment. There was evidence of subsequent growth of white matter structure, but stable intellectual insult. Conversely, in children treated with either surgery only or surgery and focal radiation to the tumor bed we observed less compromise of white matter early following treatment and no intellectual insult compared to healthy children. However, declines in intellectual function were evident for these children, though their performance remained within the average normative range. Overall, results suggest that early intervention is necessary to circumvent these deficits. There are early deficits to intellect and white matter shortly after treatment Early deficits were observed only after cranial-spinal radiation Intellectual deficits are generally stable over time White matter indices, mutism, and treatment predicted intellectual outcome
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Affiliation(s)
| | - Eric Bouffet
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Juliette Hukin
- Children's and Women's Health Centre of BC Branch, Canada
| | - Jovanka Skocic
- The Hospital for Sick Children, Toronto, Ontario, Canada
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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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10
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Brain Perfusion and Diffusion Abnormalities in Children Treated for Posterior Fossa Brain Tumors. J Pediatr 2017; 185:173-180.e3. [PMID: 28187964 DOI: 10.1016/j.jpeds.2017.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/28/2016] [Accepted: 01/06/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare cerebral perfusion and diffusion in survivors of childhood posterior fossa brain tumor with neurologically normal controls and correlate differences with cognitive dysfunction. STUDY DESIGN We analyzed retrospectively arterial spin-labeled cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) in 21 patients with medulloblastoma (MB), 18 patients with pilocytic astrocytoma (PA), and 64 neurologically normal children. We generated ANCOVA models to evaluate treatment effects on the cerebral cortex, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, and cerebral white matter at time points an average of 5.7 years after original diagnosis. A retrospective review of patient charts identified 12 patients with neurocognitive data and in whom the relationship between IQ and magnetic resonance imaging variables was assessed for each brain structure. RESULTS Patients with MB (all treated with surgery, chemotherapy, and radiation) had significantly lower global CBF relative to controls (10%-23% lower, varying by anatomic region, all adjusted P?<?.05), whereas patients with PA (all treated with surgery alone) had normal CBF. ADC was decreased specifically in the hippocampus and amygdala of patients with MB and within the amygdala of patients with PA but otherwise remained normal after therapy. In the patients with tumor previously evaluated for IQ, regional ADC, but not CBF, correlated with IQ (R2?=?0.33-0.75). CONCLUSIONS The treatment for MB, but not PA, was associated with globally reduced CBF. Treatment in both tumor types was associated with diffusion abnormalities of the mesial temporal lobe structures. Despite significant perfusion abnormalities in patients with MB, diffusion, but not perfusion, correlated with cognitive outcomes.
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11
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Sergeant A, Kameda-Smith MM, Manoranjan B, Karmur B, Duckworth J, Petrelli T, Savage K, Ajani O, Yarascavitch B, Samaan MC, Scheinemann K, Alyman C, Almenawer S, Farrokhyar F, Fleming AJ, Singh SK, Stein N. Analysis of surgical and MRI factors associated with cerebellar mutism. J Neurooncol 2017; 133:539-552. [DOI: 10.1007/s11060-017-2462-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/06/2017] [Indexed: 11/28/2022]
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12
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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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13
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Hana A, Hana A, Dooms G, Boecher-Schwarz H, Hertel F. Depiction of dentatorubrothalamic tract fibers in patients with Parkinson's disease and multiple sclerosis in deep brain stimulation. BMC Res Notes 2016; 9:345. [PMID: 27431652 PMCID: PMC4950228 DOI: 10.1186/s13104-016-2162-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We wanted to depict fibers of the dentatorubrothalamic tract in patients with Parkinson's disease and multiple sclerosis in order to use this knowledge for clinical routine and to show its relation to the corticospinal tract for deep brain stimulation. Fibers of these white matter tracts were depicted between February 2014 and February 2015 in nine patients of all ages. There were seven men and two women. The mean age was 60 years. We used a 3DT1 sequence for the navigation. Additional scanning time was less than 9 min. Both tracts were portrayed in all patients. RESULTS We were able to successfully portray these white matter tracts in all patients. We visualized the medial and lateral parts of the corticospinal tract by using a region of interest which covered the whole motor cortex. Furthermore we segmented the motor cortex. The fibers ran from this area of the brain through the internal capsule and they could be followed until their entry in the brainstem. The dentatorubrothalamic tract was smaller than the corticospinal tract. It was situated medio-posteriorly of the corticospinal tract. After decussation to the contralateral red nucleus it was localised next to the midline when it entered the motor cortex. From the thalamus on, it proceeds medially and posteriorly of the corticospinal tract further to the motor cortex. Depiction of the whole tract is essential for the differentiation of the dentatorubrothalamic tract with the corticospinal tract. CONCLUSIONS The depiction of the dentatorubrothalamic tract might be useful for neurosurgeons when deep brain stimulation is planned. Knowing its relation to other white matter tracts can help physicians like neurosurgeons or neurologists avoid side effects and deal with patients with DBS. The position of the electrode might be crucial for a satisfactory outcome.
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Affiliation(s)
- Ardian Hana
- />National Service of Neurosurgery, Centre Hospitalier de Luxembourg, Rue Barblé 25, 1210 Luxembourg, Luxembourg
| | - Anisa Hana
- />Internal Medicine Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Georges Dooms
- />Service of Neuroradiology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Hans Boecher-Schwarz
- />National Service of Neurosurgery, Centre Hospitalier de Luxembourg, Rue Barblé 25, 1210 Luxembourg, Luxembourg
| | - Frank Hertel
- />National Service of Neurosurgery, Centre Hospitalier de Luxembourg, Rue Barblé 25, 1210 Luxembourg, Luxembourg
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14
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Abstract
OBJECTIVES The cerebellum (CB) is known for its role in supporting processing speed (PS) and cognitive efficiencies. The CB often sustains damage from treatment and resection in pediatric patients with posterior fossa tumors. Limited research suggests that CB atrophy may be associated with the radiation treatment experienced during childhood. The purpose of the study was to measure cerebellar atrophy to determine its neurobehavioral correlates. METHODS Brain magnetic resonance images were collected from 25 adult survivors of CB tumors and age- and gender-matched controls (M age= 24 years (SD=5), 52% female). Average age at diagnosis was 9 years (SD=5) and average time since diagnosis was 15 years (SD=5). PS was measured by the Symbol Digit Modality Test. To quantify atrophy, an objective formula was developed based on prior literature, in which Atrophy=[(CB White+CB Gray Volume)/Intracranial Vault (ICV)]controls-[(CB White+CB Gray+Lesion Size Volume)/ICV]survivors. RESULTS Regression analyses found that the interaction term (age at diagnosis*radiation) predicts CB atrophy; regression equations included the Neurological Predictor Scale, lesion size, atrophy, and the interaction term and accounted for 33% of the variance in oral PS and 48% of the variance in written PS. Both interactions suggest that individuals with smaller CB lesion size but a greater degree of CB atrophy had slower PS, whereas individuals with a larger CB lesion size and less CB atrophy were less affected. CONCLUSION The results of the current study suggest that young age at diagnosis and radiation is associated with CB atrophy, which interacts with lesion size to impact both written and oral PS.
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15
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Travis KE, Leitner Y, Ben-Shachar M, Yeom KW, Feldman HM. Case Series: Fractional Anisotropy Profiles of the Cerebellar Peduncles in Adolescents Born Preterm With Ventricular Dilation. J Child Neurol 2016; 31:321-7. [PMID: 26116381 PMCID: PMC4691425 DOI: 10.1177/0883073815592223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/06/2015] [Indexed: 11/17/2022]
Abstract
This case series assesses white matter microstructure of the cerebellar peduncles in 4 adolescents born preterm with enlarged ventricles and reduced white matter volume in the cerebrum but no apparent injury to the cerebellum. Subjects (ages 12-17 years, gestational age 26-32 weeks, birth weight 825-2211 g) were compared to a normative sample of 19 full-term controls (9-17 years, mean gestational age 39 weeks, mean birth weight 3154 g). Tract profiles for each of the cerebellar peduncles were generated by calculating fractional anisotropy at 30 points along the central portion of each tract. One or more case subjects exhibited higher fractional anisotropy beyond the 90th percentile in the inferior, middle, and superior cerebellar peduncles. Findings demonstrate that differences in cerebellar white matter microstructure can be detected in the absence of macrostructural cerebellar abnormalities.
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Affiliation(s)
- Katherine E Travis
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yael Leitner
- Child Development Center, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ben-Shachar
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel Department of English Literature and Linguistics, Bar Ilan University, Ramat Gan, Israel
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Heidi M Feldman
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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16
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Gillio-Meina C, Zielke HR, Fraser DD. Translational Research in Pediatrics IV: Solid Tissue Collection and Processing. Pediatrics 2016; 137:peds.2015-0490. [PMID: 26659457 DOI: 10.1542/peds.2015-0490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
Solid tissues are critical for child-health research. Specimens are commonly obtained at the time of biopsy/surgery or postmortem. Research tissues can also be obtained at the time of organ retrieval for donation or from tissue that would otherwise have been discarded. Navigating the ethics of solid tissue collection from children is challenging, and optimal handling practices are imperative to maximize tissue quality. Fresh biopsy/surgical specimens can be affected by a variety of factors, including age, gender, BMI, relative humidity, freeze/thaw steps, and tissue fixation solutions. Postmortem tissues are also vulnerable to agonal factors, body storage temperature, and postmortem intervals. Nonoptimal tissue handling practices result in nucleotide degradation, decreased protein stability, artificial posttranslational protein modifications, and altered lipid concentrations. Tissue pH and tryptophan levels are 2 methods to judge the quality of solid tissue collected for research purposes; however, the RNA integrity number, together with analyses of housekeeping genes, is the new standard. A comprehensive clinical data set accompanying all tissue samples is imperative. In this review, we examined: the ethical standards relating to solid tissue procurement from children; potential sources of solid tissues; optimal practices for solid tissue processing, handling, and storage; and reliable markers of solid tissue quality.
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Affiliation(s)
- Carolina Gillio-Meina
- Translational Research Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | | | - Douglas D Fraser
- Translational Research Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Centre for Critical Illness Research, Critical Care Medicine and Pediatrics, Clinical Neurologic Sciences, and Physiology and Pharmacology, Western University, London, Ontario, Canada
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17
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Adin ME, Kleinberg L, Vaidya D, Zan E, Mirbagheri S, Yousem DM. Hyperintense Dentate Nuclei on T1-Weighted MRI: Relation to Repeat Gadolinium Administration. AJNR Am J Neuroradiol 2015; 36:1859-65. [PMID: 26294649 DOI: 10.3174/ajnr.a4378] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/19/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A hyperintense appearance of the dentate nucleus on T1-weighted MR images has been related to various clinical conditions, but the etiology remains indeterminate. We aimed to investigate the possible associations between a hyperintense appearance of the dentate nucleus on T1-weighted MR images in patients exposed to radiation and factors including, but not limited to, the cumulative number of contrast-enhanced MR images, amount of gadolinium administration, dosage of ionizing radiation, and patient demographics. MATERIALS AND METHODS The medical records of 706 consecutive patients who were treated with brain irradiation at The Johns Hopkins Medical Institutions between 1995 and 2010 were blindly reviewed by 2 readers. RESULTS One hundred eighty-four subjects were included for dentate nuclei analysis. Among the 184 subjects who cumulatively underwent 2677 MR imaging studies following intravenous gadolinium administration, 103 patients had hyperintense dentate nuclei on precontrast T1-weighted MR images. The average number of gadolinium-enhanced MR imaging studies performed in the group with normal dentate nuclei was significantly lower than that of the group with hyperintense dentate nuclei. The average follow-up time was 62.5 months. No significant difference was observed between hyperintense and normal dentate nuclei groups in terms of exposed radiation dose, serum creatinine and calcium/phosphate levels, patient demographics, history of chemotherapy, and strength of the scanner. No dentate nuclei abnormalities were found on the corresponding CT scans of patients with hyperintense dentate nuclei (n = 44). No dentate nuclei abnormalities were found in 53 healthy volunteers. CONCLUSIONS Repeat performance of gadolinium-enhanced studies likely contributes to a long-standing hyperintense appearance of dentate nuclei on precontrast T1-weighted-MR images.
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Affiliation(s)
- M E Adin
- From the Division of Neuroradiology (M.E.A., E.Z., S.M., D.M.Y.), The Russell H. Morgan Department of Radiology and Radiological Science
| | - L Kleinberg
- Department of Radiation Oncology and Radiation Molecular Sciences (L.K.)
| | - D Vaidya
- Johns Hopkins Bloomberg School of Public Health (D.V.), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - E Zan
- From the Division of Neuroradiology (M.E.A., E.Z., S.M., D.M.Y.), The Russell H. Morgan Department of Radiology and Radiological Science
| | - S Mirbagheri
- From the Division of Neuroradiology (M.E.A., E.Z., S.M., D.M.Y.), The Russell H. Morgan Department of Radiology and Radiological Science
| | - D M Yousem
- From the Division of Neuroradiology (M.E.A., E.Z., S.M., D.M.Y.), The Russell H. Morgan Department of Radiology and Radiological Science
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