Predicting cognitive outcomes in glioma patients using multimodal imaging and normative brain atlases
14th May 2021
Martin Kocher, Christiane Jockwitz, Philipp Lohmann, Gabriele Stoffels, Christian Filss, Felix M. Mottaghy, Maximilian I. Ruge, Carolin Weiss Lucas, Roland Goldbrunner, Nadim J. Shah, Gereon R. Fink, Norbert Galldiks, Karl-Josef Langen and Svenja Caspers
Glioma treatment is complex, and typically, patients undergo an extended sequence of therapeutic interventions, including repeated tumour resection, irradiation, re-irradiation, and multiple courses of chemotherapy or targeted molecular therapy. Due to the nature of these aggressive interventions, cognitive deficits are common in glioma patients following multimodality therapy, but the relative impact of different types and locations of treatment-related brain damage and recurrent tumours on cognition is not well understood.
Using a combination of MRI, O-(2-[18F]fluoroethyl)-L-tyrosine FET-PET and neuropsychological testing, this research aimed to assess the influence of treatment on cognitive test scores relative to a cohort of matched healthy subjects.
It was found that T2/FLAIR hyperintensities, presumably caused by radiation therapy, covered more extensive brain areas than other lesion types and significantly impaired cognitive performance in many domains. In contrast, brain tissue damage caused by resection or recurrent tumours appeared to impact cognitive function less severely. In particular, it was found that verbal episodic memory was especially vulnerable to T2/FLAIR abnormalities affecting the nodes and tracts of the left temporal lobe.
This research suggests that radiotherapy planning for glioma patients should employ publicly available brain atlases, in conjunction with elastic registration techniques, similar to neuronavigation in neurosurgery in order to preserve cognitive function.
Original publication: