title: The effect of IDH1 mutation on the structural connectome in malignant astrocytoma.
abstract: Mutation of the IDH1 gene is associated with differences in malignant astrocytoma growth characteristics that impact phenotypic severity, including cognitive impairment. We previously demonstrated greater cognitive impairment in patients with IDH1 wild type tumor compared to those with IDH1 mutant, and therefore we hypothesized that brain network organization would be lower in patients with wild type tumors. Volumetric, T1-weighted MRI scans were obtained retrospectively from 35 patients with IDH1 mutant and 32 patients with wild type malignant astrocytoma (mean age = 45 ± 14 years) and used to extract individual level, gray matter connectomes. Graph theoretical analysis was then applied to measure efficiency and other connectome properties for each patient. Cognitive performance was categorized as impaired or not and random forest classification was used to explore factors associated with cognitive impairment. Patients with wild type tumor demonstrated significantly lower network efficiency in several medial frontal, posterior parietal and subcortical regions (p < 0.05, corrected for multiple comparisons). Patients with wild type tumor also demonstrated significantly higher incidence of cognitive impairment (p = 0.03). Random forest analysis indicated that network efficiency was inversely, though nonlinearly associated with cognitive impairment in both groups (p < 0.0001). Cognitive reserve appeared to mediate this relationship in patients with mutant tumor suggesting greater neuroplasticity and/or benefit from neuroprotective factors. Tumor volume was the greatest contributor to cognitive impairment in patients with wild type tumor, supporting our hypothesis that greater lesion momentum between grades may cause more disconnection of core neurocircuitry and consequently lower efficiency of information processing.
authors.affiliation: Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 431, Houston, TX, 77030, USA. skesler@mdanderson.org.
authors.forename: Shelli R
authors.initials: SR
authors.lastname: Kesler
authors.affiliation: Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 431, Houston, TX, 77030, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Noll
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Neurosurgical Service, Boston, MA, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Cahill
authors.affiliation: Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.affiliation: Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 431, Houston, TX, 77030, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Wefel
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000150:complications / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology*; D001921:Brain / Q000000981:diagnostic imaging / Q000502:physiology*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000209:etiology; D063132:Connectome; D005260:Female; D006801:Humans; D007521:Isocitrate Dehydrogenase / Q000235:genetics*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009154:Mutation
chemical_list: D007521:Isocitrate Dehydrogenase; C543588:IDH1 protein, human
keywords: Astrocytoma; Cognition; Connectome; IDH1; MRI