Diffusion-Tensor Imaging for the Detection and Quantification of Treatment-Induced White Matter Injury in Children with Medulloblastoma: A Pilot Study
Pek-Lan Khong1,
Dora L. W. Kwong2,
Godfrey C. F. Chan3,
Jonathan S. T. Sham2,
Fu-Luk Chan1 and
Gaik-Cheng Ooi1
1 Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Hong Kong
2 Department of Clinical Oncology, Queen Mary Hospital, University of Hong Kong, Hong Kong
3 Department of Pediatrics, Queen Mary Hospital, University of Hong Kong, Hong Kong
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FIG 1. Axial T2-weighted images (100/4000/2 [TE/TR/NEX]) showing the locations of typical ROIs used in the study.
A, Bilateral cerebellar hemispheres.
B, Pons.
C, Medulla oblongata.
D, Bilateral frontal periventricular WM.
E, Bilateral parietal periventricular WM.
F, Bilateral corona radiata.
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FIG 2. Healthy 10-year-old control showing MR images at the level of the basal ganglia
A, Axial T2-weighted images (100/4000/2 [TE/TR/NEX]).
B, Axial echo-planar spin-echo DT imaging-derived FA maps (minimum/10000/1200/1 [TE/TR/b factor/NEX]; b = 1200 s/mm2 x 25 directions and b = 0).
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FIG 3. A 10-year-old medulloblastoma survivor with treatment-induced WM injury and postsurgical complications of hydrocephalus and shunt infection.
A, Axial T2-weighted images (100/4000/2 [TE/TR/NEX]).
B, Axial echo-planar spin-echo DT imaging-derived FA maps (minimum/10000/1200/1 [TE/TR/b factor/NEX]; b = 1200 s/mm2 x 25 directions and b = 0) showing (a) grade 3 white matter changes and (b) reduced signal intensity in the WM compared with the healthy age-matched control, in keeping with reduced FA.
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FIG 4. Graph showing relationship between severity of deterioration of school performance of the nine medulloblastoma survivors, and percentage reduction in supratentorial FA of the medulloblastoma survivors compared with healthy age-matched controls. 1, mild deterioration; 2, moderate deterioration; 3, severe deterioration.
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