Brain Perfusion and Diffusion Abnormalities in Children Treated for Posterior Fossa Brain Tumors

Matthew D. Li, Nils D. Forkert, Palak Kundu, Cheryl Ambler, Robert M. Lober, Terence Burns, Patrick D. Barnes, Iris C. Gibbs, Gerald A. Grant, Paul G. Fisher, Samuel H. Cheshier, Cynthia J. Campen, Michelle Monje, Kristen W. Yeom

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)173-180.e3
JournalJournal of Pediatrics
Volume185
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

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Infratentorial Neoplasms
Brain Neoplasms
Cerebrovascular Circulation
Perfusion
Medulloblastoma
Brain
Astrocytoma
Amygdala
Hippocampus
Globus Pallidus
Putamen
Nucleus Accumbens
Temporal Lobe
Therapeutics
Thalamus
Cerebral Cortex
Survivors
Neoplasms
Magnetic Resonance Imaging

Keywords

  • ASL perfusion
  • cognitive dysfunction
  • DWI
  • medulloblastoma
  • pilocytic astrocytoma
  • therapy effects

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Brain Perfusion and Diffusion Abnormalities in Children Treated for Posterior Fossa Brain Tumors. / Li, Matthew D.; Forkert, Nils D.; Kundu, Palak; Ambler, Cheryl; Lober, Robert M.; Burns, Terence; Barnes, Patrick D.; Gibbs, Iris C.; Grant, Gerald A.; Fisher, Paul G.; Cheshier, Samuel H.; Campen, Cynthia J.; Monje, Michelle; Yeom, Kristen W.

In: Journal of Pediatrics, Vol. 185, 01.06.2017, p. 173-180.e3.

Research output: Contribution to journalArticle

Li, MD, Forkert, ND, Kundu, P, Ambler, C, Lober, RM, Burns, T, Barnes, PD, Gibbs, IC, Grant, GA, Fisher, PG, Cheshier, SH, Campen, CJ, Monje, M & Yeom, KW 2017, 'Brain Perfusion and Diffusion Abnormalities in Children Treated for Posterior Fossa Brain Tumors', Journal of Pediatrics, vol. 185, pp. 173-180.e3. https://doi.org/10.1016/j.jpeds.2017.01.019
Li, Matthew D. ; Forkert, Nils D. ; Kundu, Palak ; Ambler, Cheryl ; Lober, Robert M. ; Burns, Terence ; Barnes, Patrick D. ; Gibbs, Iris C. ; Grant, Gerald A. ; Fisher, Paul G. ; Cheshier, Samuel H. ; Campen, Cynthia J. ; Monje, Michelle ; Yeom, Kristen W. / Brain Perfusion and Diffusion Abnormalities in Children Treated for Posterior Fossa Brain Tumors. In: Journal of Pediatrics. 2017 ; Vol. 185. pp. 173-180.e3.
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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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AU - Li, Matthew D.

AU - Forkert, Nils D.

AU - Kundu, Palak

AU - Ambler, Cheryl

AU - Lober, Robert M.

AU - Burns, Terence

AU - Barnes, Patrick D.

AU - Gibbs, Iris C.

AU - Grant, Gerald A.

AU - Fisher, Paul G.

AU - Cheshier, Samuel H.

AU - Campen, Cynthia J.

AU - Monje, Michelle

AU - Yeom, Kristen W.

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N2 - 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.

AB - 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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KW - pilocytic astrocytoma

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