White matter alterations in pediatric brainstem glioma: An national brain tumor registry of China study

Abstract

BackgroundPrevious studies have identified alterations in structural connectivity of patients with glioma. However, white matter (WM) integrity measured by diffusion kurtosis imaging (DKI) in pediatric patients with brainstem glioma (BSG) was lack of study. Here, the alterations in WM of patients with BSG were assessed through DKI analyses.Materials and methodsThis study involved 100 patients with BSG from the National Brain Tumor Registry of China (NBTRC) and 50 age- and sex-matched healthy controls from social recruitment. WM tracts were segmented and reconstructed using U-Net and probabilistic bundle-specific tracking. Next, automatic fiber quantitative (AFQ) analyses of WM tracts were performed using tractometry module embedded in TractSeg.ResultsWM quantitative analysis identified alterations in DKI-derived values in patients with BSG compared with healthy controls. WM abnormalities were detected in the projection fibers involved in the brainstem, including corticospinal tract (CST), superior cerebellar peduncle (SCP), middle cerebellar peduncle (MCP) and inferior cerebellar peduncle (ICP). Significant WM alterations were also identified in commissural fibers and association fibers, which were away from tumor location. Statistical analyses indicated the severity of WM abnormality was statistically correlated with the preoperative Karnofsky Performance Scale (KPS) and symptom duration of patients respectively.ConclusionThe results of this study indicated the widely distributed WM alterations in patients with BSG. DKI-derived quantitative assessment may provide additional information and insight into comprehensively understanding the neuropathological mechanisms of brainstem glioma.

Uncovering Individualized Cerebellar Atrophy Pattern and Behavioral Links in Children with Brainstem Tumor

“…Impairment of the pontocerebellar fibers can lead to axonal transport obstruction between the cerebellum and brainstem, causing damage to the cerebellar tract and subsequent deformation of cerebellar neurons (17). Additionally, disruptions of the middle cerebellar peduncles in patients with brainstem tumors were observed in our previous white matter study (1). Thirdly, interruption of transsynaptic communication between the pontine and cerebellar regions directly impacts the fiber projection from cerebellar relay neurons to the Purkinje cells in the cerebellar cortex, resulting in irreversible functional inactivation and long-term structural changes in the cerebellum (59).…”

Automated three-dimensional major white matter bundle segmentation using diffusion magnetic resonance imaging

“…TractSeg has been applied to assess various neurological disorders, including amyotrophic lateral sclerosis (Tu et al 2020 ), schizophrenia spectrum disorders (Wasserthal et al 2020 , 2021 ), traumatic brain injury (Tallus et al 2022 ), ischemic stroke (Egorova-Brumley et al 2022 ), and pediatric brainstem glioma (Zhang et al 2022b ) (Fig. 11 ), and it shows changes in diffusion MRI measures in individual white matter fiber bundles in patients compared with healthy controls.…”

“…The red dotted lines above the lines of the patients’ group and the controls indicates all positions with the tract for which the P -value is < alphaFWE. Adapted and reproduced with permission from (Zhang et al 2022b ) …”

Demyelinating disease as a differential diagnosis of diffuse midline glioma: report of two cases

“…ADEM manifests as encephalopathy with multifocal symptoms of the CNS, with characteristics of demyelination on magnetic resonance imaging (MRI) 1 . Brainstem gliomas are malignant heterogeneous glial neoplasms, representing 15-20% of CNS tumors, with a predominance in the pediatric population and with a clinical expression involving cranial nerves, long tracts, and the cerebellum 2 . Distinguishing between both pathologies due to their similar clinical presentation and MRI findings, especially when the clinical course is monophasic, poses a diagnostic challenge.…”