Kocher Martin, Jockwitz Christiane, Lohmann Philipp, Stoffels Gabriele, Filss Christian, Mottaghy Felix M, Ruge Maximilian I, Weiss Lucas Carolin, Goldbrunner Roland, Shah Nadim J, Fink Gereon R, Galldiks Norbert, Langen Karl-Josef, Caspers Svenja
Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany.
Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany.
Cancers (Basel). 2021 May 14;13(10):2373. doi: 10.3390/cancers13102373.
Cognitive deficits are common in glioma patients following multimodality therapy, but the relative impact of different types and locations of treatment-related brain damage and recurrent tumors on cognition is not well understood. In 121 WHO Grade III/IV glioma patients, structural MRI, -(2-[18F]fluoroethyl)-L-tyrosine FET-PET, and neuropsychological testing were performed at a median interval of 14 months (range, 1-214 months) after therapy initiation. Resection cavities, T1-enhancing lesions, T2/FLAIR hyperintensities, and FET-PET positive tumor sites were semi-automatically segmented and elastically registered to a normative, resting state (RS) fMRI-based functional cortical network atlas and to the JHU atlas of white matter (WM) tracts, and their influence on cognitive test scores relative to a cohort of matched healthy subjects was assessed. T2/FLAIR hyperintensities presumably caused by radiation therapy covered more extensive brain areas than the other lesion types and significantly impaired cognitive performance in many domains when affecting left-hemispheric RS-nodes and WM-tracts as opposed to brain tissue damage caused by resection or recurrent tumors. Verbal episodic memory proved to be especially vulnerable to T2/FLAIR abnormalities affecting the nodes and tracts of the left temporal lobe. In order to improve radiotherapy planning, publicly available brain atlases, in conjunction with elastic registration techniques, should be used, similar to neuronavigation in neurosurgery.
认知缺陷在接受多模态治疗的胶质瘤患者中很常见，但治疗相关脑损伤和复发性肿瘤的不同类型及位置对认知的相对影响尚不清楚。在121例世界卫生组织III/IV级胶质瘤患者中，在治疗开始后中位间隔14个月（范围1 - 214个月）进行了结构磁共振成像（MRI）、[¹⁸F]氟乙基-L-酪氨酸（FET）正电子发射断层扫描（PET）和神经心理学测试。对切除腔、T1增强病变、T2/液体衰减反转恢复序列（FLAIR）高信号以及FET-PET阳性肿瘤部位进行半自动分割，并弹性配准到基于静息态功能磁共振成像（fMRI）的标准功能皮质网络图谱以及约翰霍普金斯大学白质（WM）束图谱，评估它们相对于匹配的健康受试者队列对认知测试分数的影响。与由切除或复发性肿瘤导致的脑组织损伤相比，推测由放射治疗引起的T2/FLAIR高信号覆盖的脑区更广泛，当影响左半球静息态节点和白质束时，在许多领域显著损害认知表现。言语情景记忆被证明对影响左颞叶节点和束的T2/FLAIR异常特别敏感。为了改进放射治疗计划，应使用公开可用的脑图谱并结合弹性配准技术，类似于神经外科手术中的神经导航。
