Quantitative Imaging Biomarkers of Damage to Critical Memory Regions Are Associated With Post-Radiation Therapy Memory Performance in Brain Tumor Patients

Published on Nov 15, 2019in International Journal of Radiation Oncology Biology Physics7.038
路 DOI :10.1016/J.IJROBP.2019.08.003
Kathryn R. Tringale11
Estimated H-index: 11
(MSK: Memorial Sloan Kettering Cancer Center),
Tanya T. Nguyen18
Estimated H-index: 18
+ 12 AuthorsJona A. Hattangadi-Gluth23
Estimated H-index: 23
Sources
Abstract
Abstract Purpose We used quantitative MRI to prospectively analyze the association between microstructural damage to memory-associated structures within the medial temporal lobe and longitudinal memory performance after brain radiotherapy (RT). Methods and Materials Primary brain tumor patients receiving fractionated brain RT were enrolled on a prospective trial (n=27). Patients underwent high resolution volumetric brain MRI, diffusion-weighted imaging, and neurocognitive testing prior to and 3, 6, and 12 months post-RT. Medial temporal lobe regions (hippocampus; entorhinal, parahippocampal, and temporal pole white matter [WM]) were auto-segmented, quantifying volume and diffusion biomarkers of WM integrity (mean diffusivity [MD]; fractional anisotropy [FA]). Reliable change indices (RCI) measured changes in verbal (Hopkins Verbal Learning Test-Revised [HVLT-R]) and visuospatial (Brief Visuospatial Memory Test-Revised [BVMT-R]) memory. Linear mixed-effects models assessed longitudinal associations between imaging parameters and memory. Results Visuospatial memory significantly declined at 6 months post-RT (mean RCI -1.3, P=.012). Concurrent chemotherapy and seizures trended toward a significant association with greater decline in visuospatial memory (P=.053, P=.054, respectively). Higher mean dose to the left temporal pole WM was significantly associated with decreased FA (r=-.667, P=.002). Over all time points, smaller right hippocampal volume (P=.021), lower right entorhinal FA (P=.023), greater right entorhinal MD (P=.047), and greater temporal pole MD (BVMT-R Total Recall, P=.003; BVMT-R Delayed Recall, P=.042) were associated with worse visuospatial memory. The interaction between right entorhinal MD (BVMT-R Total Recall, P=.021; BVMT-R Delayed Recall, P=.004), and temporal pole FA (BVMT-R Delayed Recall, P=.024) significantly predicted visuospatial memory performance. Conclusions Brain tumor patients exhibited visuospatial memory decline post-RT. Microstructural damage to critical memory regions, including the hippocampus and medial temporal lobe WM, were associated with post-RT memory decline. The integrity of medial temporal lobe structures is critical to memory performance post-RT, representing possible avoidance targets for memory preservation.
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Diffusion tensor imaging (DTI) studies have detected white matter microstructural changes in essential tremor (ET). However, it is still unclear whether these changes are related to cognitive deficits, which have been described in ET patients. DTI-derived fractional anisotropy, mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity measures were compared between 23 ET patients and 23 age-, gender-, and education-matched healthy individuals, using whole-brain tract-based spatial st...
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