Drabek-Maunder Emily R, Gains Jenny, Hargrave Darren R, Mankad Kshitij, Aquilina Kristian, Dean Jamie A, Nisbet Andrew, Clark Chris A
Great Ormond Street Institute of Child Health, University College London, London, UK.
Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
Neurooncol Adv. 2025 Mar 5;7(1):vdaf053. doi: 10.1093/noajnl/vdaf053. eCollection 2025 Jan-Dec.
Pediatric brain tumor survivors can have neurocognitive deficits that negatively impact their quality of life, but it is unclear if deficits are primarily caused by treatments, such as radiotherapy, or manifest earlier due to the tumor and related complications. The aim of this work is to characterize white matter injury caused by brain tumors, unrelated to treatment effects, and explore heterogeneity in these white matter abnormalities between individual patients.
We used diffusion tensor imaging and neurite orientation dispersion diffusion imaging to assess white matter injury in 8 posterior fossa tumor patients. A novel one-against-many approach was used by comparing an individual patient to 20 age- and sex-matched healthy controls to assess variability in white matter abnormalities between the posterior fossa tumor patients. White matter was analyzed at presentation (prior to treatment), postsurgery (24-72 hours after surgery), and at follow-up (3-18 months after surgery).
We demonstrate white matter abnormalities in 5 posterior fossa tumor patients before treatment, likely related to tumor-induced hydrocephalus, which persisted after treatment. White matter changes were complex and patient-specific, and group-based comparisons with control subjects may fail to detect these individual abnormalities.
Identifying pretreatment white matter injury in posterior fossa tumor patients highlights the importance of personalized assessment of brain microstructure, which should be considered in minimizing neurocognitive deficits to improve patient quality of life.
小儿脑肿瘤幸存者可能存在神经认知缺陷，对其生活质量产生负面影响，但尚不清楚这些缺陷主要是由放疗等治疗引起，还是因肿瘤及相关并发症而更早出现。本研究的目的是描述由脑肿瘤引起的、与治疗效果无关的白质损伤，并探讨个体患者之间这些白质异常的异质性。
我们使用扩散张量成像和神经突方向离散度扩散成像来评估8例后颅窝肿瘤患者的白质损伤。采用一种新颖的一对一多比较方法，将个体患者与20名年龄和性别匹配的健康对照进行比较，以评估后颅窝肿瘤患者之间白质异常的变异性。在就诊时（治疗前）、术后（手术后24 - 72小时）和随访时（手术后3 - 18个月）对白质进行分析。
我们在5例后颅窝肿瘤患者治疗前发现了白质异常，可能与肿瘤引起的脑积水有关，治疗后仍持续存在。白质变化复杂且具有个体特异性，与对照受试者进行基于组的比较可能无法检测到这些个体异常。
识别后颅窝肿瘤患者治疗前的白质损伤凸显了对脑微结构进行个性化评估的重要性，在尽量减少神经认知缺陷以提高患者生活质量时应予以考虑
