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Pre-Surgery Cognitive Performance and Voxel-Based Lesion-Symptom Mapping in Patients with Left High-Grade Glioma
Article

Lesion-Function Analysis from Multimodal Imaging and Normative Brain Atlases for Prediction of Cognitive Deficits in Glioma Patients

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Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany
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Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany
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Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany
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Institute of Neuroscience and Medicine (INM-1), Research Center Juelich, 52428 Juelich, Germany
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Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany
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Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
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Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany
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Department of Neurology, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany
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Juelich-Aachen Research Alliance (JARA)–Section JARA-Brain, 52428 Juelich, Germany
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Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, 52428 Juelich, Germany
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Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
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Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
*
Author to whom correspondence should be addressed.
Academic Editors: Giuseppe Lombardi, Alberto Feletti and Anna Luisa Di Stefano
Cancers 2021, 13(10), 2373; https://doi.org/10.3390/cancers13102373
Received: 8 April 2021 / Revised: 9 May 2021 / Accepted: 10 May 2021 / Published: 14 May 2021
This prospective cross-sectional study utilized standard structural MR imaging and amino acid PET in conjunction with brain atlases of gray matter functional regions and white matter tracts, and elastic registration techniques to estimate the influence of the type and location of treatment-related brain damage or recurrent tumors on cognitive functioning in a group of well-doing WHO Grade III/IV glioma patients at follow-up after treatment. The negative impact of T2/FLAIR hyperintensities, supposed to be mainly caused by radiotherapy, on cognitive performance far exceeded that of surgical brain defects or recurrent tumors. The affection of functional nodes and fiber tracts of the left hemisphere and especially of the left temporal lobe by T2/FLAIR hyperintensities was highly correlated with verbal episodic memory dysfunction. These observations imply that radiotherapy for gliomas of the left hemisphere should be individually tailored by means of publicly available brain atlases and registration techniques.
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 tumors on cognition is not well understood. In 121 WHO Grade III/IV glioma patients, structural MRI, O-(2-[18F]fluoroethyl)-L-tyrosine FET-PET, and neuropsychological testing were performed at a median interval of 14 months (range, 1–214 months) after therapy initiation. Resection cavities, T1-enhancing lesions, T2/FLAIR hyperintensities, and FET-PET positive tumor sites were semi-automatically segmented and elastically registered to a normative, resting state (RS) fMRI-based functional cortical network atlas and to the JHU atlas of white matter (WM) tracts, and their influence on cognitive test scores relative to a cohort of matched healthy subjects was assessed. T2/FLAIR hyperintensities presumably caused by radiation therapy covered more extensive brain areas than the other lesion types and significantly impaired cognitive performance in many domains when affecting left-hemispheric RS-nodes and WM-tracts as opposed to brain tissue damage caused by resection or recurrent tumors. Verbal episodic memory proved to be especially vulnerable to T2/FLAIR abnormalities affecting the nodes and tracts of the left temporal lobe. In order to improve radiotherapy planning, publicly available brain atlases, in conjunction with elastic registration techniques, should be used, similar to neuronavigation in neurosurgery. View Full-Text
Keywords: glioma; brain networks; positron emission tomography; radiotherapy; cognitive testing glioma; brain networks; positron emission tomography; radiotherapy; cognitive testing
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MDPI and ACS Style

Kocher, M.; Jockwitz, C.; Lohmann, P.; Stoffels, G.; Filss, C.; Mottaghy, F.M.; Ruge, M.I.; Weiss Lucas, C.; Goldbrunner, R.; Shah, N.J.; Fink, G.R.; Galldiks, N.; Langen, K.-J.; Caspers, S. Lesion-Function Analysis from Multimodal Imaging and Normative Brain Atlases for Prediction of Cognitive Deficits in Glioma Patients. Cancers 2021, 13, 2373. https://doi.org/10.3390/cancers13102373

AMA Style

Kocher M, Jockwitz C, Lohmann P, Stoffels G, Filss C, Mottaghy FM, Ruge MI, Weiss Lucas C, Goldbrunner R, Shah NJ, Fink GR, Galldiks N, Langen K-J, Caspers S. Lesion-Function Analysis from Multimodal Imaging and Normative Brain Atlases for Prediction of Cognitive Deficits in Glioma Patients. Cancers. 2021; 13(10):2373. https://doi.org/10.3390/cancers13102373

Chicago/Turabian Style

Kocher, Martin, 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. 2021. "Lesion-Function Analysis from Multimodal Imaging and Normative Brain Atlases for Prediction of Cognitive Deficits in Glioma Patients" Cancers 13, no. 10: 2373. https://doi.org/10.3390/cancers13102373

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