title: Brain Perfusion and Diffusion Abnormalities in Children Treated for Posterior Fossa Brain Tumors.
abstract: To compare cerebral perfusion and diffusion in survivors of childhood posterior fossa brain tumor with neurologically normal controls and correlate differences with cognitive dysfunction.
  
  
  
  We analyzed retrospectively arterial spin-labeled cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) in 21 patients with medulloblastoma (MB), 18 patients with pilocytic astrocytoma (PA), and 64 neurologically normal children. We generated ANCOVA models to evaluate treatment effects on the cerebral cortex, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, and cerebral white matter at time points an average of 5.7 years after original diagnosis. A retrospective review of patient charts identified 12 patients with neurocognitive data and in whom the relationship between IQ and magnetic resonance imaging variables was assessed for each brain structure.
  
  
  
  Patients with MB (all treated with surgery, chemotherapy, and radiation) had significantly lower global CBF relative to controls (10%-23% lower, varying by anatomic region, all adjusted P?<?.05), whereas patients with PA (all treated with surgery alone) had normal CBF. ADC was decreased specifically in the hippocampus and amygdala of patients with MB and within the amygdala of patients with PA but otherwise remained normal after therapy. In the patients with tumor previously evaluated for IQ, regional ADC, but not CBF, correlated with IQ (R2?=?0.33-0.75).
  
  
  
  The treatment for MB, but not PA, was associated with globally reduced CBF. Treatment in both tumor types was associated with diffusion abnormalities of the mesial temporal lobe structures. Despite significant perfusion abnormalities in patients with MB, diffusion, but not perfusion, correlated with cognitive outcomes.
authors.affiliation: Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Li
authors.affiliation: Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
authors.forename: Nils D
authors.initials: ND
authors.lastname: Forkert
authors.affiliation: Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Palak
authors.initials: P
authors.lastname: Kundu
authors.affiliation: N.E.A.T. Private Practice, Los Altos, CA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ambler
authors.affiliation: Department of Neurosurgery, Dayton Children's Hospital, Boonshoft School of Medicine, Dayton, OH.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lober
authors.affiliation: Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford University, Stanford, CA.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Burns
authors.affiliation: Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Barnes
authors.affiliation: Department of Radiation Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Iris C
authors.initials: IC
authors.lastname: Gibbs
authors.affiliation: Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford University, Stanford, CA.
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Grant
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Fisher
authors.affiliation: Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford University, Stanford, CA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Cheshier
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Campen
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Monje
authors.affiliation: Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA. Electronic address: kyeom@stanford.edu.
authors.forename: Kristen W
authors.initials: KW
authors.lastname: Yeom
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000503:physiopathology / Q000628:therapy; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000503:physiopathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000503:physiopathology / Q000628:therapy; D009483:Neuropsychological Tests; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: ASL perfusion; DWI; cognitive dysfunction; medulloblastoma; pilocytic astrocytoma; therapy effects