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Hou J, King TZ, Chen H, Wang Q, Xie Y, Mao H, Wang L, Cheng L. Concurrent brain structural and functional alterations in the thalamus of adult survivors of childhood brain tumors: a multimodal MRI study. Brain Res Bull 2024; 211:110937. [PMID: 38570077 DOI: 10.1016/j.brainresbull.2024.110937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 03/20/2024] [Accepted: 03/31/2024] [Indexed: 04/05/2024]
Abstract
Adult survivors of childhood brain tumors often present with cognitive deficits that affect their quality of life. Studying brain structure and function in brain tumor survivors can help understand the underlying mechanisms of their cognitive deficits to improve long-term prognosis of these patients. This study analyzed voxel-based morphometry (VBM) derived from T1-weighted MRI and the amplitude of low-frequency fluctuation (ALFF) from resting-state functional magnetic resonance imaging (rs-fMRI) to examine the structural and functional alterations in 35 brain tumor survivors using 35 matching healthy individuals as controls. Compared with healthy controls, brain tumor survivors had decreased gray matter volumes (GMV) in the thalamus and increased GMV in the superior frontal gyrus. Functionally, brain tumor survivors had lower ALFF values in the inferior temporal gyrus and medial prefrontal area and higher ALFF values in the thalamus. Importantly, we found concurrent but negatively correlated structural and functional alterations in the thalamus based on observed significant differences in GMV and ALFF values. These findings on concurrent brain structural and functional alterations provide new insights towards a better understanding of the cognitive deficits in brain tumor survivors.
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Affiliation(s)
- Jinfeng Hou
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Nanning Research Institute, Guilin University of Electronic Technology, Nanning 530000, China
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Hongbo Chen
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Guangxi Colleges and Universities Key Laboratory of Biomedical Sensors and Intelligent Instruments, Guilin 541004, China; Guangxi Human Physiological Information Non-Invasive Detection Engineering Technology Research Center, Guilin 541004, China; Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guilin 541004, China
| | - Qian Wang
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Nanning Research Institute, Guilin University of Electronic Technology, Nanning 530000, China
| | - You Xie
- Guilin Municipal Hospital of Traditional Chinese Medicine, Guilin 541004, China
| | - Hui Mao
- Department of Radiology and Imaging Science, Emory University, Atlanta, GA, USA
| | - Liya Wang
- Department of Radiology, The Fist Affiliated Hospital of Nanchang University, Shenzhen Hezheng Hospital, Shenzhen, Guangdong 518109, China.
| | - Luqi Cheng
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Guangxi Colleges and Universities Key Laboratory of Biomedical Sensors and Intelligent Instruments, Guilin 541004, China; Guangxi Human Physiological Information Non-Invasive Detection Engineering Technology Research Center, Guilin 541004, China; Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guilin 541004, China; Zhejiang Lab, Hangzhou 311100, China.
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Fox ME, Turner JA, Crosson B, Morris RD, King TZ. Functional Connectivity Networks and Their Recruitment During Working Memory Tasks in Adult Survivors of Childhood Brain Tumors. Brain Connect 2021; 11:822-837. [PMID: 33858201 DOI: 10.1089/brain.2020.0800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Assessments of functional connectivity of default mode network (DMN) and positive task-related networks (TRNs) using independent component analysis (ICA) may help describe long-term effects of childhood brain tumors and adjuvant treatments. Methods: Aiming to identify potential neuronal markers that may aid in prognosis and inform interventions to optimize outcomes, this study used ICA to evaluate the presence of functional connectivity networks and their recruitment during a letter n-back task in 23 adult survivors of childhood posterior fossa tumors (9 low grade, 14 high grade) at least 5 years past diagnosis compared with 40 age- and sex-matched healthy peers. Results: DMN components generally demonstrated increasing disengagement as task difficulty increased, and relationships between effective DMN disengagement and improved performance were observed in healthy controls (HCs). Low-grade brain tumor survivors (LGS) demonstrated unique patterns in DMN recruitment that suggested increased involvement of the medial prefrontal cortex in LGS during tasks. TRN components generally demonstrated increasing engagement, which was related to improved task performance in HCs for one executive control network (ECN) component. High-grade brain tumor survivors (HGS) demonstrated distinct challenges recruiting an ECN component at more difficult task levels and showed a relationship between recruitment of another ECN component and task performance, indicating a potential compensatory mechanism for some HGS. Conclusions: Findings suggest the importance of cognitive intervention in both survivor groups and the necessity to track LGS despite their cognitive abilities often resembling those of their healthy peers. Impact statement Distinct functional connectivity patterns were identified between both adult survivor of childhood brain tumor groups and peers during attention and working memory tasks, reflecting different damage and recovery from treatment. Survivors of low-grade tumors demonstrated unique patterns of recruitment of default mode network components in the context of similar cognitive abilities, whereas survivors of high-grade tumors demonstrated poorer cognitive abilities and may be utilizing compensatory executive control network components in the face of challenging tasks. Long-term clinical follow-up and cognitive remediation is warranted for both groups, including low grade cerebellar tumor patients who have traditionally not been monitored as closely.
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Affiliation(s)
- Michelle E Fox
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Jessica A Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| | - Bruce Crosson
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA.,Departments of Neurology and of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Center of Excellence for Visual and Neurocognitive Rehabilitation, Decatur, Georgia, USA
| | - Robin D Morris
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
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Sleurs C, Blommaert J, Batalle D, Verly M, Sunaert S, Peeters R, Lemiere J, Uyttebroeck A, Deprez S. Cortical thinning and altered functional brain coherence in survivors of childhood sarcoma. Brain Imaging Behav 2021; 15:677-688. [PMID: 32335825 DOI: 10.1007/s11682-020-00276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
High-dose chemotherapy is increasingly evidenced to be neurotoxic and result in long-term neurocognitive sequelae. However, research investigating grey matter alterations in childhood cancer patients remains limited. As childhood sarcoma patients receive high-dose chemotherapy, we aimed to investigate cortical brain alterations in adult survivors. We analyzed high-resolution structural (T1-weighted) MRI and resting-state functional MRI (rsfMRI), to derive structural and functional cortical information in survivors of childhood sarcoma, treated with high-dose intravenous chemotherapy (n = 33). These scans were compared to age- and gender- matched controls (n = 34). Cortical volume and thickness were investigated using voxel-based morphometry and vertex-wise surface-based morphometry. Brain regions showing significant group differences in volume or thickness were implemented as seeds of interest to estimate their resting state co-activity with other areas (i.e. functional coherence). We explored whether structural measures were associated with potential risk factors, such as age at diagnosis, and cumulative doses of chemotherapeutic agents (methotrexate, ifosfamide). Finally, we investigated the link between functional regional strength, neurocognitive assessments and daily life complaints. In patients relative to controls we observed lower grey matter volumes in cerebellar and frontal areas, as well as frontal cortical thinning. Cerebellar volume and orbitofrontal thickness appeared dose- and age-related, respectively. Cortical thickness of the parahippocampal area appeared lower, only if the group comparison was not adjusted for depression. This region specifically showed lower functional coherence, which was associated with lower processing speed. This study suggests cortical thinning as well as decreased functional coherence in survivors of childhood sarcoma, which could be important for both long-term attentional functioning and emotional distress in daily life. Frontal areas might be specifically vulnerable during adolescence.
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Affiliation(s)
| | | | - Dafnis Batalle
- Department of Forensic & Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marjolein Verly
- Department of Neurosciences, ExpORL, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Ron Peeters
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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O’Neil SH, Whitaker AM, Kayser K, Nelson MB, Finlay JL, Dhall G, Sands S. Neuropsychological outcomes on Head Start III: a prospective, multi-institutional clinical trial for young children diagnosed with malignant brain tumors. Neurooncol Pract 2020; 7:329-337. [PMID: 32537181 PMCID: PMC7274184 DOI: 10.1093/nop/npz071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current pediatric brain tumor treatment focuses on titrating toxicity based on risk factors while simultaneously improving survivorship. The Head Start (HS) protocols I to IV (1991-present) use high-dose chemotherapy (HDCTx) with an aim of reducing or eliminating cranial irradiation in very young children, the most vulnerable to its effects. METHODS We examined estimated Full Scale IQ, overall Adaptive Functioning, Working Memory, Processing Speed, and Verbal and Nonverbal Memory outcome data for 43 HS III patients diagnosed between ages 2 months and 7 years from 15 institutions in the United States and Canada. RESULTS At a mean of 5.12 years postdiagnosis, the HS III patients performed within the average to low-average ranges across these variables; however, individual variability was noted with scores ranging from superior to impaired, and the sample as a whole performed lower than age expectations. Performance did not significantly differ by sex or ethnicity, diagnosis, or for those treated with an intravenous methotrexate dose of 400 mg/kg vs 270 mg/kg. Additionally, performance did not significantly differ by age at diagnosis or length of follow-up. CONCLUSIONS The results, indicating overall average to low-average neurocognitive functioning, are encouraging, though significant individual variability was noted. Those who were younger at diagnosis, received more intensive methotrexate, and were further out from treatment were not at significantly increased risk of cognitive decline within our sample, suggesting a strategy of using HDCTx and autologous hematopoietic progenitor cell rescue to reduce or eliminate irradiation may allow for continued CNS development in young children treated for a brain tumor.
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Affiliation(s)
- Sharon H O’Neil
- The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Division of Neurology, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ashley M Whitaker
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Kimberly Kayser
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Mary Baron Nelson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Jonathan L Finlay
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Girish Dhall
- University of Alabama at Birmingham Division of Hematology, Oncology, and Blood & Marrow Transplantation, Birmingham, AL
| | - Stephen Sands
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering, New York, NY
- Department of Pediatrics, Memorial Sloan Kettering, New York, NY
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5
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Ailion AS, Roberts SR, Crosson B, King TZ. Neuroimaging of the component white matter connections and structures within the cerebellar-frontal pathway in posterior fossa tumor survivors. NEUROIMAGE-CLINICAL 2019; 23:101894. [PMID: 31229941 PMCID: PMC6593203 DOI: 10.1016/j.nicl.2019.101894] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/07/2019] [Accepted: 06/08/2019] [Indexed: 12/11/2022]
Abstract
Introduction In posterior fossa tumor survivors, lower white matter integrity (WMI) in the right cerebellar-left frontal pathway has been well documented and appears to be related to proximity to the cerebellum, radiation treatment, as well as time since treatment in both cranial radiation and surgery-only treatment groups. The current study investigated theories of transneural degeneration following cerebellar tumor resection that may underlie or relate to reductions in WMI and regional brain volumes using correlations. We hypothesized a positive relationship between the volume of the right cerebellum and known white matter output pathways, as well as with the volume of structures that receive cerebellar projections along the pathway. Methods Adult survivors of childhood brain tumors were recruited (n = 29; age, M = 22 years, SD = 5; 45% female). Age- and gender-matched controls were also included (n = 29). Participants completed 3 T diffusion-weighted and T1 MPRAGE MRI scans. Brain structure volume relative to intracranial vault served as regional volumetric measures. Fractional anisotropy (FA) and radial diffusivity (RD) served as WMI measures. In the survivor group, partial correlations between WMI and regional volume included controlling for disease severity. Results In posterior fossa tumor survivors, the volumes of the cerebellum, thalamus, and frontal lobe were correlated with WMI of the thalamic-frontal segment of the cerebellar-frontal pathway (r = 0.41–0.49, p < .05). Cerebellar atrophy was correlated with reduced WMI in the cerebellar-rubral segment (FA, r = −0.32 p > .05; RD, r = 0.53, p < .01). In the no-radiation survivor group, the regional volume of each structure along the pathway was associated with WMI in the cerebellar-rubral segment. In the radiation survivor group, significant correlations were found between the regional brain volume of each structure and the thalamic-frontal segment of the pathway. Discussion The results of this multimodal neuroimaging study provide correlational evidence that the mechanism of injury subsequent to brain tumor treatment may be different depending on type of treatment(s). Without radiation, the primary mechanism of injury is cerebellar tumor growth, resection, and hydrocephalus. Therefore, the most proximal connection to that injury (cerebellar-rubral pathway) was correlated with reductions in volume along the pathway. In contrast, the survivor group treated with radiation may have had possible radiation-induced demyelination of the thalamic-frontal portion of the pathway, based on a strong correlation with volume loss in the cerebellum, red nucleus, thalamus, and frontal lobe. Cerebellar atrophy predicted lower white matter integrity (WMI) in the cerebellar-rubral segment. The no-radiation group showed a correlational pattern that is consistent with possible transneural degeneration. The radiation group showed a correlational pattern consistent with theories of neurodevelopmental vulnerability to radiation-induced demyelination.
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Affiliation(s)
- Alyssa S Ailion
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America
| | - Simone Renée Roberts
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America; Department of Neurology, Emory University School of Medicine, United States of America; Atlanta VA Center of Excellence for Visual and Neurocognitive Rehabilitation, United States of America
| | - Bruce Crosson
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America; Department of Radiology and Imaging Sciences, Emory University School of Medicine, United States of America; Department of Neurology, Emory University School of Medicine, United States of America; Atlanta VA Center of Excellence for Visual and Neurocognitive Rehabilitation, United States of America
| | - Tricia Z King
- Department of Psychology, the Neuroscience Institute, Georgia State University, United States of America.
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6
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Self- and informant-rated apathy in patients with childhood-onset craniopharyngioma. J Neurooncol 2018; 140:27-35. [DOI: 10.1007/s11060-018-2936-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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Marusak HA, Iadipaolo AS, Harper FW, Elrahal F, Taub JW, Goldberg E, Rabinak CA. Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive, behavioral, and emotional outcomes. Neuropsychol Rev 2018; 28:123-175. [PMID: 29270773 PMCID: PMC6639713 DOI: 10.1007/s11065-017-9365-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023]
Abstract
Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine's true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent "cure" that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer - namely, the presence of a life-threatening disease and endurance of invasive medical procedures - has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.
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Affiliation(s)
- Hilary A Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA.
| | - Allesandra S Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Felicity W Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Farrah Elrahal
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Elimelech Goldberg
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Kids Kicking Cancer, Southfield, MI, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA
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Abstract
Statistical parametric maps formed via voxel-wise mass-univariate tests, such as the general linear model, are commonly used to test hypotheses about regionally specific effects in neuroimaging cross-sectional studies where each subject is represented by a single image. Despite being informative, these techniques remain limited as they ignore multivariate relationships in the data. Most importantly, the commonly employed local Gaussian smoothing, which is important for accounting for registration errors and making the data follow Gaussian distributions, is usually chosen in an ad hoc fashion. Thus, it is often suboptimal for the task of detecting group differences and correlations with non-imaging variables. Information mapping techniques, such as searchlight, which use pattern classifiers to exploit multivariate information and obtain more powerful statistical maps, have become increasingly popular in recent years. However, existing methods may lead to important interpretation errors in practice (i.e., misidentifying a cluster as informative, or failing to detect truly informative voxels), while often being computationally expensive. To address these issues, we introduce a novel efficient multivariate statistical framework for cross-sectional studies, termed MIDAS, seeking highly sensitive and specific voxel-wise brain maps, while leveraging the power of regional discriminant analysis. In MIDAS, locally linear discriminative learning is applied to estimate the pattern that best discriminates between two groups, or predicts a variable of interest. This pattern is equivalent to local filtering by an optimal kernel whose coefficients are the weights of the linear discriminant. By composing information from all neighborhoods that contain a given voxel, MIDAS produces a statistic that collectively reflects the contribution of the voxel to the regional classifiers as well as the discriminative power of the classifiers. Critically, MIDAS efficiently assesses the statistical significance of the derived statistic by analytically approximating its null distribution without the need for computationally expensive permutation tests. The proposed framework was extensively validated using simulated atrophy in structural magnetic resonance imaging (MRI) and further tested using data from a task-based functional MRI study as well as a structural MRI study of cognitive performance. The performance of the proposed framework was evaluated against standard voxel-wise general linear models and other information mapping methods. The experimental results showed that MIDAS achieves relatively higher sensitivity and specificity in detecting group differences. Together, our results demonstrate the potential of the proposed approach to efficiently map effects of interest in both structural and functional data.
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Affiliation(s)
- Erdem Varol
- Section for Biomedical Image Analysis, Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Aristeidis Sotiras
- Section for Biomedical Image Analysis, Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Christos Davatzikos
- Section for Biomedical Image Analysis, Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
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9
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Ailion AS, Hortman K, King TZ. Childhood Brain Tumors: a Systematic Review of the Structural Neuroimaging Literature. Neuropsychol Rev 2017. [DOI: 10.1007/s11065-017-9352-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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10
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Zhang T, Casanova R, Resnick SM, Manson JE, Baker LD, Padual CB, Kuller LH, Bryan RN, Espeland MA, Davatzikos C. Effects of Hormone Therapy on Brain Volumes Changes of Postmenopausal Women Revealed by Optimally-Discriminative Voxel-Based Morphometry. PLoS One 2016; 11:e0150834. [PMID: 26974440 PMCID: PMC4790922 DOI: 10.1371/journal.pone.0150834] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/20/2016] [Indexed: 01/25/2023] Open
Abstract
Backgrounds The Women's Health Initiative Memory Study Magnetic Resonance Imaging (WHIMS-MRI) provides an opportunity to evaluate how menopausal hormone therapy (HT) affects the structure of older women’s brains. Our earlier work based on region of interest (ROI) analysis demonstrated potential structural changes underlying adverse effects of HT on cognition. However, the ROI-based analysis is limited in statistical power and precision, and cannot provide fine-grained mapping of whole-brain changes. Methods We aimed to identify local structural differences between HT and placebo groups from WHIMS-MRI in a whole-brain refined level, by using a novel method, named Optimally-Discriminative Voxel-Based Analysis (ODVBA). ODVBA is a recently proposed imaging pattern analysis approach for group comparisons utilizing a spatially adaptive analysis scheme to accurately locate areas of group differences, thereby providing superior sensitivity and specificity to detect the structural brain changes over conventional methods. Results Women assigned to HT treatments had significant Gray Matter (GM) losses compared to the placebo groups in the anterior cingulate and the adjacent medial frontal gyrus, and the orbitofrontal cortex, which persisted after multiple comparison corrections. There were no regions where HT was significantly associated with larger volumes compared to placebo, although a trend of marginal significance was found in the posterior cingulate cortical area. The CEE-Alone and CEE+MPA groups, although compared with different placebo controls, demonstrated similar effects according to the spatial patterns of structural changes. Conclusions HT had adverse effects on GM volumes and risk for cognitive impairment and dementia in older women. These findings advanced our understanding of the neurobiological underpinnings of HT effects.
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Affiliation(s)
- Tianhao Zhang
- Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Ramon Casanova
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland, United States of America
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Laura D. Baker
- Department of Internal Medicine and Epidemiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Claudia B. Padual
- Sierra Pacific Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
| | - Lewis H. Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - R. Nick Bryan
- Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Fuentes D, Contreras J, Yu J, He R, Castillo E, Castillo R, Guerrero T. Morphometry-based measurements of the structural response to whole-brain radiation. Int J Comput Assist Radiol Surg 2014; 10:393-401. [PMID: 25408306 DOI: 10.1007/s11548-014-1128-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Morphometry techniques were applied to quantify the normal tissue therapy response in patients receiving whole-brain radiation for intracranial malignancies. METHODS Pre- and Post-irradiation magnetic resonance imaging (MRI) data sets were retrospectively analyzed in N = 15 patients. Volume changes with respect to pre-irradiation were quantitatively measured in the cerebrum and ventricles. Measurements were correlated with the time interval from irradiation. Criteria for inclusion included craniospinal irradiation, pre-irradiation MRI, at least one follow-up MRI, and no disease progression. The brain on each image was segmented to remove the skull and registered to the initial pre-treatment scan. Average volume changes were measured using morphometry analysis of the deformation Jacobian and direct template registration-based segmentation of brain structures. RESULTS An average cerebral volume atrophy of -0.2 and -3% 3% was measured for the deformation morphometry and direct segmentation methods, respectively. An average ventricle volume dilation of 21 and 20% was measured for the deformation morphometry and direct segmentation methods, respectively. CONCLUSION The presented study has developed an image processing pipeline for morphometric monitoring of brain tissue volume changes as a response to radiation therapy. Results indicate that quantitative morphometric monitoring is feasible and may provide additional information in assessing response.
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Affiliation(s)
- D Fuentes
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA,
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Genschaft M, Huebner T, Plessow F, Ikonomidou VN, Abolmaali N, Krone F, Hoffmann A, Holfeld E, Vorwerk P, Kramm C, Gruhn B, Koustenis E, Hernaiz-Driever P, Mandal R, Suttorp M, Hummel T, Ikonomidou C, Kirschbaum C, Smolka MN. Impact of chemotherapy for childhood leukemia on brain morphology and function. PLoS One 2013; 8:e78599. [PMID: 24265700 PMCID: PMC3827075 DOI: 10.1371/journal.pone.0078599] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/21/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Using multidisciplinary treatment modalities the majority of children with cancer can be cured but we are increasingly faced with therapy-related toxicities. We studied brain morphology and neurocognitive functions in adolescent and young adult survivors of childhood acute, low and standard risk lymphoblastic leukemia (ALL), which was successfully treated with chemotherapy. We expected that intravenous and intrathecal chemotherapy administered in childhood will affect grey matter structures, including hippocampus and olfactory bulbs, areas where postnatal neurogenesis is ongoing. METHODS We examined 27 ALL-survivors and 27 age-matched healthy controls, ages 15-22 years. ALL-survivors developed disease prior to their 11th birthday without central nervous system involvement, were treated with intrathecal and systemic chemotherapy and received no radiation. Volumes of grey, white matter and olfactory bulbs were measured on T1 and T2 magnetic resonance images manually, using FIRST (FMRIB's integrated Registration and Segmentation Tool) and voxel-based morphometry (VBM). Memory, executive functions, attention, intelligence and olfaction were assessed. RESULTS Mean volumes of left hippocampus, amygdala, thalamus and nucleus accumbens were smaller in the ALL group. VBM analysis revealed significantly smaller volumes of the left calcarine gyrus, both lingual gyri and the left precuneus. DTI data analysis provided no evidence for white matter pathology. Lower scores in hippocampus-dependent memory were measured in ALL-subjects, while lower figural memory correlated with smaller hippocampal volumes. INTERPRETATION Findings demonstrate that childhood ALL, treated with chemotherapy, is associated with smaller grey matter volumes of neocortical and subcortical grey matter and lower hippocampal memory performance in adolescence and adulthood.
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Affiliation(s)
- Marina Genschaft
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Huebner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Franziska Plessow
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Vasiliki N. Ikonomidou
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, Fairfax, Virginia, United States of America
| | - Nasreddin Abolmaali
- Klinik und Poliklinik für Diagnostische Radiologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franziska Krone
- Interdisciplinary Center for Smell and Taste, Dept. of ORL, Technische Universität Dresden, Dresden, Germany
| | - Andre Hoffmann
- Klinik für Kinder- und Jugendmedizin, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - Elisabeth Holfeld
- Klinik für Kinder- und Jugendmedizin, Carl-Thieme-Klinikum Cottbus, Cottbus, Germany
| | - Peter Vorwerk
- Department of Pediatrics, University of Magdeburg, Magdeburg, Germany
| | - Christof Kramm
- University Children’s Hospital, University Medical Centre Halle, Halle, Germany
| | - Bernd Gruhn
- Department of Pediatrics, University of Jena, Jena, Germany
| | - Elisabeth Koustenis
- Pediatric Neurooncology Program, Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pablo Hernaiz-Driever
- Pediatric Neurooncology Program, Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rakesh Mandal
- Department of Pathology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Meinolf Suttorp
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Hummel
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, Fairfax, Virginia, United States of America
| | - Chrysanthy Ikonomidou
- Department of Neurology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
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Zhang T, Davatzikos C. Optimally-Discriminative Voxel-Based Morphometry significantly increases the ability to detect group differences in schizophrenia, mild cognitive impairment, and Alzheimer's disease. Neuroimage 2013; 79:94-110. [PMID: 23631985 DOI: 10.1016/j.neuroimage.2013.04.063] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 04/16/2013] [Accepted: 04/18/2013] [Indexed: 11/28/2022] Open
Abstract
Optimally-Discriminative Voxel-Based Analysis (ODVBA) (Zhang and Davatzikos, 2011) is a recently-developed and validated framework of voxel-based group analysis, which transcends limitations of traditional Gaussian smoothing in the forms of analysis such as the General Linear Model (GLM). ODVBA estimates the optimal non-stationary and anisotropic filtering of the data prior to statistical analyses to maximize the ability to detect group differences. In this paper, we extensively evaluate ODVBA to three sets of previously published data from studies in schizophrenia, mild cognitive impairment, and Alzheimer's disease, and evaluate the regions of structural difference identified by ODVBA versus standard Gaussian smoothing and other related methods. The experimental results suggest that ODVBA is considerably more sensitive in detecting group differences, presumably because of its ability to adapt the regional filtering to the underlying extent and shape of a group difference, thereby maximizing the ability to detect such difference. Although there is no gold standard in these clinical studies, ODVBA demonstrated highest significance in group differences within the identified voxels. In terms of spatial extent of detected area, agreement of anatomical boundary, and classification, it performed better than other tested voxel-based methods and competitively with the cluster enhancing methods.
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Affiliation(s)
- Tianhao Zhang
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, PA, USA.
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Zou P, Li Y, Conklin HM, Mulhern RK, Butler RW, Ogg RJ. Evidence of change in brain activity among childhood cancer survivors participating in a cognitive remediation program. Arch Clin Neuropsychol 2012; 27:915-29. [PMID: 23079152 DOI: 10.1093/arclin/acs095] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Increased understanding of the underlying mechanisms of cognitive remediation is needed to facilitate development of intervention strategies for childhood cancer survivors experiencing cognitive late effects. Accordingly, a pilot functional magnetic resonance imaging (fMRI) study was conducted with 14 cancer survivors (12.02 ± 0.09 years old), who participated in a cognitive remediation clinical trial, and 28 healthy children (12.7 ± 0.6 years old). The ventral visual areas, cerebellum, supplementary motor area, and left inferior frontal cortex were significantly activated in the healthy participants during a continuous performance task. In survivors, brain activation in these regions was diminished at baseline, and increased upon completion of remediation and at a 6-month follow-up. The fMRI activation index for each region of interest was inversely associated with the Conners' Clinical Competence Index (p<.01). The pilot study suggests that fMRI is useful in evaluating neural responses to cognitive remediation.
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Affiliation(s)
- Ping Zou
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Palmer SL, Reddick WE, Glass JO, Ogg R, Patay Z, Wallace D, Gajjar A. Regional white matter anisotropy and reading ability in patients treated for pediatric embryonal tumors. Brain Imaging Behav 2010; 4:132-40. [PMID: 20502994 DOI: 10.1007/s11682-010-9092-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children treated with cranial irradiation for brain tumors have reduced white matter volume and deficits in reading ability. This study prospectively examined the relationship between reading and white matter integrity within this patient group. Patients (n = 54) were treated with post-surgical radiation followed by 4 cycles of high-dose chemotherapy with stem cell support. At 12 months post-diagnosis, all patients completed a neuropsychology evaluation and a diffusion tensor imaging (DTI) exam. White matter integrity was determined through measures of fractional anisotropy (FA). Significant group differences in FA were found between above average readers and below average readers within the left and right posterior limb of the internal capsule, and right knee of the internal capsule with a trend within the left temporaloccipital region. The integrity of the white matter in these regions may affect communication among visual, auditory, and language cortical areas that are engaged during reading.
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Reddick WE, Glass JO, Johnson DP, Laningham FH, Pui CH. Voxel-based analysis of T2 hyperintensities in white matter during treatment of childhood leukemia. AJNR Am J Neuroradiol 2009; 30:1947-54. [PMID: 19643920 DOI: 10.3174/ajnr.a1733] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE White matter (WM) hyperintensities on T2-weighted MR imaging are the most common imaging manifestation of neurotoxic effects of therapy for central nervous system (CNS) prophylaxis in childhood acute lymphoblastic leukemia (ALL). This study uses voxel-based analyses (VBA) of T2-weighted imaging of patients during treatment to identify which WM regions are preferentially damaged. MATERIALS AND METHODS Two sets of conventional T2-weighted axial images were acquired on a 1.5T MR imaging scanner from 197 consecutive patients (85 female, 112 male; aged 1.0-18.9 years) enrolled on an institutional ALL treatment protocol. Images were acquired after completion of induction therapy and after the final of the 4 courses of intravenous high-dose methotrexate in consolidation therapy (3.9 +/- 0.8 months apart). Voxel-wise statistical testing of the incremental change between normalized longitudinal T2 images was performed with radiologist reading (normal or abnormal) and treatment risk-group as covariates. RESULTS Two highly significant bilateral clusters of T2 signal intensity change were identified in both 1-group and 2-group analyses. The regions were symmetric in size, shape, and average signal intensity. Increased T2-weighted signal intensity from these regions both within and between examinations were nonlinear functions of age at examination, and the difference between the examinations was greater for older subjects who received more intense therapy. CONCLUSIONS These analyses identified specific WM tracts involving predominantly the anterior, superior, and posterior corona radiata and superior longitudinal fasciculus, which were at increased risk for the development of T2-weighted hyperintensities during therapy for childhood ALL. These vulnerable regions may be the cause of subsequent cognitive difficulties consistently observed in survivors.
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Affiliation(s)
- W E Reddick
- Division of Translational Imaging Research, St. Jude Children's Research Hospital, Memphis, TN, USA.
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