Li Matthew D, Forkert Nils D, Kundu Palak, Ambler Cheryl, Lober Robert M, Burns Terry C, Barnes Patrick D, Gibbs Iris C, Grant Gerald A, Fisher Paul G, Cheshier Samuel H, Campen Cynthia J, Monje Michelle, Yeom Kristen W
Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
J Pediatr. 2017 Jun;185:173-180.e3. doi: 10.1016/j.jpeds.2017.01.019. Epub 2017 Feb 7.
To compare cerebral perfusion and diffusion in survivors of childhood posterior fossa brain tumor with neurologically normal controls and correlate differences with cognitive dysfunction.
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.
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 (R?=?0.33-0.75).
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.
比较儿童后颅窝脑肿瘤幸存者与神经功能正常的对照者的脑灌注和扩散情况，并将差异与认知功能障碍相关联。
我们回顾性分析了21例髓母细胞瘤（MB）患者、18例毛细胞型星形细胞瘤（PA）患者和64例神经功能正常儿童的动脉自旋标记脑血流量（CBF）和表观扩散系数（ADC）。我们建立了协方差分析模型，以评估在原诊断后平均5.7年的时间点，治疗对大脑皮质、丘脑、尾状核、壳核、苍白球、海马体、杏仁核、伏隔核和脑白质的影响。对患者病历进行回顾性审查，确定了12例有神经认知数据的患者，并评估了每个脑结构中智商与磁共振成像变量之间的关系。
MB患者（均接受手术、化疗和放疗）的全脑CBF相对于对照组显著降低（低10%-23%，因解剖区域而异，所有校正P<0.05），而PA患者（均仅接受手术治疗）的CBF正常。ADC在MB患者的海马体和杏仁核以及PA患者的杏仁核中特异性降低，但治疗后其他部位仍保持正常。在先前评估过智商的肿瘤患者中，区域ADC而非CBF与智商相关（R=0.33-0.75）。
MB而非PA的治疗与全脑CBF降低有关。两种肿瘤类型的治疗均与内侧颞叶结构的扩散异常有关。尽管MB患者存在明显的灌注异常，但与认知结果相关的是扩散而非灌注。
