Division of Pediatrics, Department of Medicine-DAME, University of Udine, Udine, Italy.
Division of Pediatrics, University Hospital of Udine, Udine, Italy.
Pediatr Blood Cancer. 2020 Sep;67(9):e28538. doi: 10.1002/pbc.28538. Epub 2020 Jul 11.
Cerebellar tumor survivors often exhibit neuropsychological deficits that could be related to alterations in cerebro-cerebellar networks. This is a pilot study designed to understand if diffusion tensor imaging (DTI)-based tractography is able to identify possible correlations between cerebellar white matter structure and cognitive outcome in children on long-term follow-up for posterior fossa (PF) tumors who were thoroughly assessed for neuropsychological functioning.
DTI-based tractography was performed in pediatric patients with PF tumors. Fractional anisotropy (FA) and volumetric measurements of spinocerebellar, dentorubrothalamocortical and corticopontocerebellar tracts were analyzed. Cognitive and neuropsychological functioning was assessed by the Wechsler Intelligence Scale for Children-IV Edition (WISC-IV) and the Developmental Neuropsychological Assessment (NEPSY II). The associations between Full-Scale Intelligence Quotient (FSIQ), NEPSY-II scores, and fiber tracts were tested by the Spearman rank correlation coefficient.
Seven patients (median age at diagnosis five years, range, 3-13) treated for medulloblastoma (2/7; 29%) and pilocytic astrocytoma (5/7; 71%) were retrospectively evaluated. All children had complete surgery. The median FSIQ was 84 (range, 67-93). Patients presented with several deficits on many NEPSY-II tasks; in particular, memory was impaired in nearly half of them. FSIQ and neurocognitive tasks significantly correlated with specific corticopontocerebellar tracts.
Children on follow-up for PF tumor showed scattered cognitive impairments, including deficits in long-term and immediate memory. Tractography allowed us to describe a possible association between the integrity of cerebellar pathways and neurocognitive performance, suggesting that the myelinization of these fibers may represent an indicator for the development of long-term cognitive sequelae.
小脑肿瘤幸存者常表现出神经心理学缺陷，这可能与小脑-大脑皮质网络的改变有关。本研究旨在探讨基于弥散张量成像（DTI）的示踪技术是否能够识别后颅窝（PF）肿瘤患儿长期随访时小脑白质结构与认知结局之间的可能相关性，这些患儿已接受神经心理学功能的全面评估。
对 PF 肿瘤患儿进行基于 DTI 的示踪研究。分析小脑脚间核束、齿状核红核丘脑束和皮质脑桥小脑束的各向异性分数（FA）和体积测量值。采用韦氏儿童智力量表第四版（WISC-IV）和神经心理发育评估（NEPSY II）评估认知和神经心理学功能。采用 Spearman 秩相关系数检验全智商（FSIQ）、NEPSY-II 评分与纤维束之间的相关性。
回顾性分析了 7 例接受治疗的患者（中位诊断年龄为 5 岁，范围 3-13 岁），包括 2 例髓母细胞瘤（29%）和 5 例毛细胞型星形细胞瘤（71%）。所有患儿均行全切除手术。FSIQ 中位数为 84（范围 67-93）。患儿在多项 NEPSY-II 任务中存在多种认知缺陷，近半数患儿存在记忆障碍。FSIQ 和神经认知任务与特定的皮质脑桥小脑束显著相关。
PF 肿瘤随访患儿存在散在的认知障碍，包括长时记忆和即时记忆缺陷。示踪技术可描述小脑通路完整性与神经认知表现之间的可能关联，提示这些纤维的髓鞘形成可能是预测长期认知后遗症的指标。
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