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Atypical white matter volume
development in children following craniospinal irradiation
Wilburn E. Reddick, John O. Glass,
Shawna L. Palmer, Shingjie Wu, Amar Gajjar, James W. Langston, Larry
E. Kun, Xiaoping Xiong, and Raymond K. Mulhern
Departments of Radiological Sciences
(W.E.R., J.O.G., J.W.L., L.E.K.), Behavioral Medicine (S.L.P.,
R.K.M.), Biostatistics (S.W., X.X.), and Hematology-Oncology (A.G.),
St. Jude Children’s Research Hospital, Memphis, TN 38105;
Departments of Electrical and Computer Engineering (W.E.R.) and
Biomedical Engineering (W.E.R.), University of Memphis, Memphis, TN
38152; USA. Address correspondence to Wilburn E. Reddick, Department
of Radiological Sciences (MS #212), St. Jude Children’s Research
Hospital, 332 N. Lauderdale St., Memphis, TN 38105-2794, USA
(gene.reddick@stjude.org).
Most children with medulloblastoma
(MB), the second most common pediatric brain tumor, have a 70% probabability of survival.
However, survivors who receive aggressive therapy are at significant
risk of cognitive deficits that have been associated with lower
volumes of normalappearing white matter (NAWM).
We hypothesized that cranial irradiation inhibited normal brain volume
development in these survivors.
We retrospectively analyzed 324 MRI studies of 52 patients with
histologically proven MB treated with surgery and 35 to 40 Gy
craniospinal irradiation, with or without chemotherapy.
The volume of NAWM and that of cerebrospinal fluid were quantified
from a single index section and compared with those of healthy,
age-similar control subjects.
A quadratic random coefficient model was used to identify trends in
brain volume with increasing age.
Patients treated for MB at younger ages demonstrated substantially
less development of NAWM volume than did their healthy peers.
Younger age at the time of irradiation and the need for a ventricular
shunt were significantly associated with reduced NAWM volume.
NAWM and craniospinal fluid volume differences between patients who
had shunts and those without resolved over a period of four to five
years.
NAWM volume is known to be associated with neurocognitive test
performance, which shows deficiencies after cranial irradiation early
in life.
Therefore, volumetric monitoring of brain development can be used to
guide the care of survivors, assess the toxicity of previous and
current clinical trials, and aid in the design of therapies that
minimize toxicity.
© 2005 Duke University Press
Source: http://hermia.ingentaselect.com/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v7n1/s2/p12&user_id=undefined
DOI: http://dx.doi.org/10.1215/S1152851704000079
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