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

Cancers, vol. 13, pp. 2373

Abstract

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.

Authors 14

1. Martin Köcher corresponding

   Forschungszentrum Jülich · University of Cologne · University Hospital Cologne

   Affiliation as printed

   Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany

   Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany

   Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany

2. Christiane Jockwitz

   Forschungszentrum Jülich

   Affiliation as printed

   Institute of Neuroscience and Medicine (INM-1), Research Center Juelich, 52428 Juelich, Germany

3. Philipp Lohmann

   Forschungszentrum Jülich · University of Cologne · University Hospital Cologne

   Affiliation as printed

   Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany

   Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany

   Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany

4. Gabriele Stoffels

   Forschungszentrum Jülich

   Affiliation as printed

   Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany

5. Christian Filß

   Forschungszentrum Jülich

   Affiliation as printed

   Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany

6. Felix Manuel Mottaghy Aachen Department of Nuclear Medicine

   Maastricht University Medical Centre · Maastricht University · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany

   Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands

7. Maximilian Ingolf Ruge

   University of Cologne · University Hospital Cologne

   Affiliation as printed

   Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany

   Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany

8. Carolin Weiß Lucas

   University of Cologne · University Hospital Cologne

   Affiliation as printed

   Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany

   Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany

9. Roland Goldbrunner

   University of Cologne · University Hospital Cologne

   Affiliation as printed

   Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany

   Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany

10. Nadim Jon Shah Aachen Department of Neurology

    Forschungszentrum Jülich · Universitätsklinikum Aachen · Jülich Aachen Research Alliance · RWTH Aachen University

    Affiliation as printed

    Department of Neurology, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany

    Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany

    Juelich-Aachen Research Alliance (JARA)–Section JARA-Brain, 52428 Juelich, Germany

11. Gereon R. Fink

    Forschungszentrum Jülich · University of Cologne · University Hospital Cologne

    Affiliation as printed

    Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany

    Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany

    Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, 52428 Juelich, Germany

12. Norbert Galldiks

    Forschungszentrum Jülich · University of Cologne · University Hospital Cologne

    Affiliation as printed

    Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 50937 Cologne, Germany

    Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany

    Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, 52428 Juelich, Germany

13. Karl‐Josef Langen Aachen Department of Nuclear Medicine

    Forschungszentrum Jülich · Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany

    Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, 52428 Juelich, Germany

14. Svenja Caspers

    Forschungszentrum Jülich · Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

    Affiliation as printed

    Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany

    Institute of Neuroscience and Medicine (INM-1), Research Center Juelich, 52428 Juelich, Germany