Neuroimaging and neuropsychological follow-up study in a pediatric brain tumor patient treated with surgery and radiation
Neuroimaging and neuropsychological follow-up study in a pediatric brain tumor patient treated with surgery and radiation
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DOI：
10.1080/13554790903329133
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发表时间：
2010-01-01
期刊：
影响因子：
0.8
通讯作者：
Horska, Alena
中科院分区：
文献类型：
--
作者：
Schmidt, Adam T.;Martin, Rebecca B.;Horska, Alena
颅内肿瘤是儿童期最常见的肿瘤，约占所有儿科恶性肿瘤的20%。放射治疗直接导致患有某些类型颅内肿瘤的儿童的生存率显着提高；然而，鉴于这种疗法的侵略性，儿童面临着大脑结构、神经元生物化学和神经认知功能发生变化的风险。在本病例报告中，我们提供了两名青少年（一名患有颅内转移的室管膜脊髓肿瘤患者和一名健康的、通常发育中的对照）的神经心理学、磁共振成像、质子磁共振波谱成像和弥散张量成像数据，这些数据由患者的放射计划定义的三个时间点（患者放射治疗前的基线、患者放射治疗完成后 6 个月以及患者放射治疗后 27 个月）得出。在患者中，常规 MRI 表现正常的区域中，灰质和白质体积逐渐减少，平均 N-乙酰天冬氨酸/胆碱 (NAA/Cho) 比率和各向异性分数 (FA) 早期下降。在最后一次随访中，NAA/Cho 和 FA 在选定区域倾向于向正常值方向变化。与此同时，患者的语言和运动技能最初出现下降，随后恢复到基线，但随后视觉空间和视觉感知技能出现延迟。结果从四种技术对治疗早期和晚期影响的敏感性以及未来研究的途径进行了讨论。
Intracranial tumors are the most common neoplasms of childhood, accounting for approximately 20% of all pediatric malignancies. Radiation therapy has led directly to significant increases in survival of children with certain types of intracranial tumors; however, given the aggressive nature of this therapy, children are at risk for exhibiting changes in brain structure, neuronal biochemistry, and neurocognitive functioning. In this case report, we present neuropsychological, magnetic resonance imaging, proton magnetic resonance spectroscopic imaging, and diffusion tensor imaging data for two adolescents (one patient with ependymal spinal cord tumor with intracranial metastases, and one healthy, typically developing control) from three time points as defined by the patient's radiation schedule (baseline before the patient's radiation therapy, 6 months following completion of the patient's radiation, and 27 months following the patient's radiation). In the patient, there were progressive decreases in gray and white matter volumes as well as early decreases in mean N-acetyl aspartate/choline (NAA/Cho) ratios and fractional anisotropy (FA) in regions with normal appearance on conventional MRI. At the last follow-up, NAA/Cho and FA tended to change in the direction to normal values in selected regions. At the same time, the patient had initial reduction in language and motor skills, followed by return to baseline, but later onset delay in visuospatial and visual perceptual skills. Results are discussed in terms of sensitivity of the four techniques to early and late effects of treatment, and avenues for future investigations.