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DTI assessment of the brainstem white matter tracts in pediatric BSG before and after therapy

A report from the pediatric brain tumor consortium

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Abstract

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.

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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.

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA, 02115, USA

    Sanjay P. Prabhu, Sarah Ng, Sridhar Vajapeyam & Tina Young Poussaint

  2. Pediatric Neuro-Oncology, Dana Farber Cancer Center, 44 Binney Street, Boston, MA, 02115, USA

    Mark W. Kieran

  3. Department of Neurosurgery, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Ian F. Pollack

  4. Department of Hematology/Oncology, Seattle Children’s Hospital, 4800 Sand Point Way NE B6553, Mail Stop 6D-1, Seattle, WA, 98105, USA

    Russell Geyer

  5. Department of Radiation Oncology, University of California at San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA, 94143-1708, USA

    Daphne Haas-Kogan

  6. Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    James M. Boyett

  7. Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Larry Kun

Authors
  1. Sanjay P. Prabhu
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  2. Sarah Ng
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  3. Sridhar Vajapeyam
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  4. Mark W. Kieran
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  5. Ian F. Pollack
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  6. Russell Geyer
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  7. Daphne Haas-Kogan
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  8. James M. Boyett
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  9. Larry Kun
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  10. Tina Young Poussaint
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Corresponding author

Correspondence to Sanjay P. Prabhu.

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Prabhu, S.P., Ng, S., Vajapeyam, S. et al. DTI assessment of the brainstem white matter tracts in pediatric BSG before and after therapy. Childs Nerv Syst 27, 11–18 (2011). https://doi.org/10.1007/s00381-010-1323-7

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  • DOI: https://doi.org/10.1007/s00381-010-1323-7

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