Atypical white matter volume development in children following craniospinal irradiation
Atypical white matter volume development in children following craniospinal irradiation
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DOI：
10.1215/s1152851704000079
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发表时间：
2005-01-01
期刊：
影响因子：
15.9
通讯作者：
Mulhern, RK
中科院分区：
文献类型：
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作者：
Reddick, WE;Glass, JO;Mulhern, RK
髓母细胞瘤（MB）是第二常见的儿童脑肿瘤，大多数儿童的生存率为70%。然而，接受积极治疗的幸存者有显著的认知缺陷风险，这与较低的正常白质（NAWM）体积有关。我们假设颅照射抑制了这些幸存者正常脑容量的发育。我们回顾性分析了52例组织学证实的MB患者的324项MRI研究，这些患者接受了手术和35至40 Gy的颅脊髓照射，有或没有化疗。从单一指数切片定量测定NAWM和脑脊液的体积，并与年龄相近的健康对照组进行比较。使用二次随机系数模型确定脑容量随年龄增长的趋势。年轻时接受MB治疗的患者与健康同龄人相比，NAWM体积的发展明显减少。照射时年龄越小和需要心室分流术与naawm体积减小显著相关。NAWM和颅脊髓液容量在分流患者和未分流患者之间的差异，时间跨度为4 - 5年。已知NAWM体积与神经认知测试表现有关，这在生命早期颅脑照射后显示出缺陷。因此，脑发育的体积监测可以用来指导幸存者的护理，评估以前和现在的临床试验的毒性，并帮助设计最小化毒性的治疗方法。
Most children with medulloblastoma (MB), the second most common pediatric brain tumor, have a 70% probability of survival. However, survivors who receive aggressive therapy are at significant risk of cognitive deficits that have been associated with lower volumes of normal-appearing white matter (NAWM). We hypothesized that cranial irradiation inhibited normal brain volume development in these survivors. We retrospectively analyzed 324 MRI studies of 52 patients with histologically proven MB treated with surgery and 35 to 40 Gy craniospinal irradiation, with or without chemotherapy. The volume of NAWM and that of cerebrospinal fluid were quantified from a single index section and compared with those of healthy, age-similar control subjects. A quadratic random coefficient model was used to identify trends in brain volume with increasing age. Patients treated for MB at younger ages demonstrated substantially less development of NAWM volume than did their healthy peers. Younger age at the time of irradiation and the need for a ventricular shunt were significantly associated with reduced NAWM volume. NAWM and craniospinal fluid volume differences between patients who had shunts and those without resolved over a period of four to five years. NAWM volume is known to be associated with neurocognitive test performance, which shows deficiencies after cranial irradiation early in life. Therefore, volumetric monitoring of brain development can be used to guide the care of survivors, assess the toxicity of previous and current clinical trials, and aid in the design of therapies that minimize toxicity.