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Diffusion tensor imaging indices as biomarkers for cognitive changes following paediatric radiotherapy: a systematic
Noor Shatirah Voon1, Hanani Abdul Manan2, Noorazrul Yahya3
1Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia.
Insights
Diffusion tensor imaging (DTI) can detect white matter injury after paediatric radiotherapy, potentially serving as a biomarker for cognitive changes. Lower fractional anisotropy in the corpus callosum is linked to cognitive decline, suggesting DTI
Area of Science:
- Neuroimaging
- Oncology
- Radiotherapy
Background:
- Paediatric radiotherapy can lead to subtle white matter (WM) injury.
- Diffusion tensor imaging (DTI) shows potential for detecting WM changes.
- Cognitive decline is a known consequence of paediatric radiotherapy.
Purpose of the Study:
- To systematically review and meta-analyze the relationship between DTI indices and cognitive changes post-paediatric radiotherapy.
- To evaluate DTI as a potential biomarker for radiotherapy-induced cognitive impairment.
Main Methods:
- Systematic review and meta-analysis of studies identified via PubMed and Scopus.
- Quality assessment using the NIH Quality Assessment Tool.
- Meta-analyses performed on DTI changes in specific anatomical locations, following PRISMA guidelines.
Main Results:
- 17 out of 18 studies reported significant cognitive decline following radiotherapy.
- Significant cognitive changes were observed in patients with acute lymphoblastic leukaemia (ALL) and brain tumours (BT).
- Lower fractional anisotropy (FA) in the corpus callosum was significantly associated with cognitive decline in both ALL and BT groups (r=0.52).
Conclusions:
- White matter tract integrity, particularly in the corpus callosum measured by FA, shows potential as a biomarker for radiotherapy-related cognitive decline.
- DTI inclusion in follow-up imaging protocols for paediatric cancer survivors is recommended.
Abstract:
Diffusion tensor imaging (DTI) can detect subtle manifestations of white matter (WM) injury following paediatric radiotherapy, which may be a potential biomarker for cognitive changes. This study aimed to synthesise the relationships between DTI indices and cognitive changes following paediatric radiotherapy through systematic review and meta-analysis. PubMed and Scopus electronic databases were used to identify eligible studies. Quality assessment was performed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information on demographics, DTI changes, and associations to cognitive outcomes were extracted. Meta-analyses were performed on DTI changes in specific anatomical locations. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the preparation of this report. Eighteen studies were included (median study size: 21; range 18-146). 17/18 studies showed significant cognitive decline following irradiation. Meta-analyses found significant cognitive changes within patient's group of acute lymphoblastic leukaemia (ALL; standard mean differences [SMD] = -0.075, P = 0.01) and brain tumours (BT; SMD = -1.037, P ≤ 0.001) compared to control/baseline. Both groups also had significantly lower fractional anisotropy (FA) scores in the corpus callosum (ALL: SMD = -0.979, P = 0.002; BT: SMD = -1.025, P < 0.001). Decreased FA was consistently associated with cognitive decline. Correlation on WMFA integrity to cognitive domains was statistically significant (Z = 9.86, P < 0.001) with a large effect size (r = 0.52). White matter tract integrity of the corpus callosum measured with FA has the potential to be a biomarker for radiotherapy-related cognitive decline. Inclusion of DTI in follow-up imaging should be encouraged.
