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Correlation between changes in substructure diffusion tensor imaging and neurocognitive outcomes for pediatric brain
Ryan T Oglesby1, Leslie Chang2, Elizabeth Olatunji1
1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Neuro-Oncology Advances
|April 28, 2026
Summary
Pediatric brain tumor survivors experience neurocognitive decline linked to white matter integrity loss. Diffusion tensor imaging (DTI) reveals changes in white matter associated with cognitive function, guiding future brain-preserving strategies.
Area of Science:
- Neuroscience
- Pediatric Oncology
- Radiology
Background:
- Pediatric central nervous system (CNS) tumors are a leading cause of cancer-related mortality in children.
- Survivors often face neurocognitive deficits due to tumor location, surgery, and radiation therapy.
- Diffusion tensor imaging (DTI) is crucial for assessing white matter integrity and its impact on neurocognitive outcomes.
Purpose of the Study:
- To investigate the relationship between white matter integrity, assessed by DTI, and neurocognitive outcomes in pediatric brain tumor survivors.
- To identify specific white matter regions and DTI metrics associated with cognitive decline.
- To inform the development of treatment-sparing strategies to preserve long-term function.
Main Methods:
- Retrospective analysis of 171 neurocognitive assessments and DTI scans from 68 pediatric brain tumor patients.
- Comparison with 80 healthy controls from the Pediatric Imaging, Neurocognition, and Genetics repository.
- Quantification of DTI metrics (axial diffusivity, radial diffusivity, mean diffusivity, fractional anisotropy) across 168 neuroanatomical substructures and analysis of temporal changes.
Main Results:
- Longitudinal assessments showed median annual declines in Intelligence Quotient (IQ) and Working Memory Index (WMI).
- Significant correlations were found between white matter diffusivity changes and neurocognitive outcomes, particularly in the cerebellum, peduncles, thalamus, and corpus callosum.
- Increased axial diffusivity and mean diffusivity were linked to declines in IQ, WMI, and Processing Speed Index (PSI), while increased fractional anisotropy correlated with improved WMI.
Conclusions:
- White matter integrity loss is associated with neurocognitive decline in pediatric brain tumor survivors.
- These findings highlight the importance of monitoring white matter changes to mitigate cognitive deficits.
- The study supports interventions aimed at preserving brain function and improving survivors' quality of life.
