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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Anisotropy, Astrocytoma, Ataxia, Cerebellar Neoplasms, Child, Cognition Disorders, Diffusion Tensor Imaging, Female, Follow-Up Studies, Humans, Infratentorial Neoplasms, Intelligence Tests, Male, Medulloblastoma, Neuropsychological Tests, Prognosis, Survival Rate, Survivors, White Matter.
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Are cerebral white matter fractional anisotropy and tract volume as measured by MR imaging associated with impaired cognitive and motor function in pediatric posterior fossa tumor survivors? Context: Disease and therapy cause brain damage and subsequent functional loss in pediatric patients with posterior fossa tumors. Treatment-related toxicity factors are resection in patients with pilocytic astrocytoma (PA) and, additionally, cranio-spinal irradiation together with chemotherapy in patients with medulloblastoma (MB). We tested whether damage to white matter (WM) as revealed by diffusion tensor MR imaging (DTI) correlated with specific cognitive and motor impairments in survivors of pediatric posterior fossa tumors. Eighteen MB (mean age ± SD, 15.2 ± 4.9 y) and 14 PA (12.6 ± 5.0 y) survivors were investigated with DTI on a 3-Tesla-MR system. We identified fractional anisotropy (FA) of WM, the volume ratio of WM to gray matter and cerebrospinal fluid (WM/GM + CSF), and volume of specific frontocerebellar tracts. Ataxia was assessed using the International Cooperative Ataxia Rating Scale (ICARS), while the Wechsler Intelligence Scale for Children determined full-scale intelligence quotients (FSIQ). Amsterdam Neuropsychological Tasks (ANT) was used to assess processing speed. Handwriting automation was analyzed using a digitizing graphic tablet. The WM/GM + CSF ratio correlated significantly with cognitive measures (IQ, P = 0.002; ANT baseline speed, P = 0.04; ANT shifting attention, P = 0.004). FA of skeletonized tracts correlated significantly with FSIQ (P = 0.008), ANT baseline speed (P = 0.028) and ANT shifting attention (P = 0.045). Moreover, frontocerebellar tract volumes correlated with both the FSIQ (P = 0.011) and ICARS (P = 0.007).
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DTI provides a method for quantification of WM damage by tumor and by therapy-associated effects in survivors of pediatric posterior fossa tumors. DTI-derived WM integrity may be a representative marker for cognitive and motor deterioration. Final Decision: yes