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Published on: September 12, 2011
Using diffusion MRI to understand white matter damage and the link between brain microstructure and cognitive
Emily R Drabek-Maunder1, Kshitij Mankad2, Kristian Aquilina2
1UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; UCL Dept of Medical Physics and Biomedical Engineering, Malet Place, Gower St, London WC1E 6BT, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
Purpose:
Survivors of medulloblastoma face a range of challenges after treatment, involving behavioural, cognitive, language and motor skills. Post-treatment outcomes are associated with structural changes within the brain resulting from both the tumour and the treatment. Diffusion magnetic resonance imaging (MRI) has been used to investigate the microstructure of the brain. In this review, we aim to summarise the literature on diffusion MRI in patients treated for medulloblastoma and discuss future directions on how diffusion imaging can be used to improve patient quality.
Method:
This review summarises the current literature on medulloblastoma in children, focusing on the impact of both the tumour and its treatment on brain microstructure. We review studies where diffusion MRI has been correlated with either treatment characteristics or cognitive outcomes. We discuss the role diffusion MRI has taken in understanding the relationship between microstructural damage and cognitive and behavioural deficits.
Results:
We identified 35 studies that analysed diffusion MRI changes in patients treated for medulloblastoma. The majority of these studies found significant group differences in measures of brain microstructure between patients and controls, and some of these studies showed associations between microstructure and neurocognitive outcomes, which could be influenced by patient characteristics (e.g. age), treatment, radiation dose and treatment type.
Conclusions:
In future, studies would benefit from being able to separate microstructural white matter damage caused by the tumour, tumour-related complications and treatment. Additionally, advanced diffusion modelling methods can be explored to understand and describe microstructural changes to white matter.
Insights
Diffusion MRI reveals brain microstructure changes in medulloblastoma survivors, linking these alterations to neurocognitive outcomes. Future research should differentiate damage sources and employ advanced diffusion modeling for better patient care.
Area of Science:
- Neuroimaging
- Pediatric Oncology
- Radiology
Background:
- Medulloblastoma survivors experience long-term neurodevelopmental deficits affecting behavior, cognition, language, and motor skills.
- These deficits are linked to structural brain changes caused by the tumor and its treatment.
- Diffusion magnetic resonance imaging (MRI) is a key technique for investigating brain microstructure.
Purpose of the Study:
- To review existing literature on diffusion MRI in medulloblastoma patients.
- To correlate diffusion MRI findings with treatment characteristics and cognitive outcomes.
- To explore the role of diffusion imaging in understanding microstructural damage and its impact on patient quality of life.
Main Methods:
- Systematic review of studies analyzing diffusion MRI in medulloblastoma patients.
- Correlation analysis of diffusion MRI metrics with treatment variables (e.g., radiation dose, treatment type) and neurocognitive assessments.
- Discussion of the relationship between microstructural brain damage and functional deficits.
Main Results:
- 35 studies were included, predominantly showing significant differences in brain microstructure between medulloblastoma patients and healthy controls.
- Associations were found between microstructural integrity and neurocognitive outcomes.
- Factors like patient age, treatment modality, radiation dose, and treatment type influenced these associations.
Conclusions:
- Future studies need to disentangle white matter damage caused by the tumor, treatment, and complications.
- Advanced diffusion modeling techniques offer potential for more precise characterization of white matter changes.
- Improved understanding of microstructural damage can guide interventions to enhance survivor quality of life.
