TY - JOUR
T1 - DTI assessment of the brainstem white matter tracts in pediatric BSG before and after therapy
T2 - A report from the pediatric brain tumor consortium
AU - Prabhu, Sanjay P.
AU - Ng, Sarah
AU - Vajapeyam, Sridhar
AU - Kieran, Mark W.
AU - Pollack, Ian F.
AU - Geyer, Russell
AU - Haas-Kogan, Daphne
AU - Boyett, James M.
AU - Kun, Larry
AU - Poussaint, Tina Young
N1 - Funding Information:
Acknowledgements The authors acknowledge the support of the National Institute of Health (NIH) [U01 CA81457], the Pediatric Brain Tumor Consortium Foundation, the Pediatric Brain Tumor Foundation of the United States, and the American Lebanese–Syrian Associated Charities.
PY - 2011/1
Y1 - 2011/1
N2 - Purpose: To assess changes in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in brainstem gliomas (BSG) in children and to observe the temporal evolution of changes in the white matter tracts following therapy using diffusion tensor imaging (DTI) analysis. Methods: Serial ADC and FA measurements were obtained in three patients with newly diagnosed BSG on two approved treatment protocols. Values were compared with a set of normative ADC, FA, and eigenvalues of age-matched children of the corticospinal, transverse pontine and medial lemniscal tracts. Fiber tracking of the tracts coursing through the brainstem was performed using standard diffusion tractography analysis. Results: We found increased ADC values within tumor at baseline compared to age-matched controls, with subsequent drop following treatment and subsequent increase with recurrence. Correspondingly, FA values were reduced at presentation, but transiently recovered during the phase of tumor response to treatment, and finally decreased significantly during tumor progression. These changes were concordant with the tractography analysis of white matter tracts in the brainstem. Based on these results, we suggest that initial changes in ADC and FA values reflects tract infiltration by tumor, but not complete disruption, whereas tumor progression results in complete loss of anisotropy possibly due to tract disruption. Conclusion: Serial changes in ADC and FA values and tractography data in pediatric BSG suggest initial tumor infiltration, with transient improvement on treatment and subsequent loss of tract anisotropy during tumor progression. This technique may have potential use in assessing response to treatment regimens for pediatric BSG.
AB - Purpose: To assess changes in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in brainstem gliomas (BSG) in children and to observe the temporal evolution of changes in the white matter tracts following therapy using diffusion tensor imaging (DTI) analysis. Methods: Serial ADC and FA measurements were obtained in three patients with newly diagnosed BSG on two approved treatment protocols. Values were compared with a set of normative ADC, FA, and eigenvalues of age-matched children of the corticospinal, transverse pontine and medial lemniscal tracts. Fiber tracking of the tracts coursing through the brainstem was performed using standard diffusion tractography analysis. Results: We found increased ADC values within tumor at baseline compared to age-matched controls, with subsequent drop following treatment and subsequent increase with recurrence. Correspondingly, FA values were reduced at presentation, but transiently recovered during the phase of tumor response to treatment, and finally decreased significantly during tumor progression. These changes were concordant with the tractography analysis of white matter tracts in the brainstem. Based on these results, we suggest that initial changes in ADC and FA values reflects tract infiltration by tumor, but not complete disruption, whereas tumor progression results in complete loss of anisotropy possibly due to tract disruption. Conclusion: Serial changes in ADC and FA values and tractography data in pediatric BSG suggest initial tumor infiltration, with transient improvement on treatment and subsequent loss of tract anisotropy during tumor progression. This technique may have potential use in assessing response to treatment regimens for pediatric BSG.
KW - Brainstem glioma
KW - Diffusion tensor imaging
KW - MRI
KW - Pediatrics
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U2 - 10.1007/s00381-010-1323-7
DO - 10.1007/s00381-010-1323-7
M3 - Article
C2 - 21052693
AN - SCOPUS:78951487092
SN - 0256-7040
VL - 27
SP - 11
EP - 18
JO - Child's Nervous System
JF - Child's Nervous System
IS - 1
ER -