Quantitative imaging biomarkers of damage to critical memory regions are associated with post–radiation therapy memory performance in brain tumor patients Journal Article


Authors: Tringale, K. R.; Nguyen, T. T.; Karunamuni, R.; Seibert, T.; Huynh-Le, M. P.; Connor, M.; Moiseenko, V.; Gorman, M. K.; Marshall, A.; Tibbs, M. D.; Farid, N.; Simpson, D.; Sanghvi, P.; McDonald, C. R.; Hattangadi-Gluth, J. A.
Article Title: Quantitative imaging biomarkers of damage to critical memory regions are associated with post–radiation therapy memory performance in brain tumor patients
Abstract: Purpose: We used quantitative magnetic resonance imaging to prospectively analyze the association between microstructural damage to memory-associated structures within the medial temporal lobe and longitudinal memory performance after brain radiation therapy (RT). Methods and Materials: Patients with a primary brain tumor receiving fractionated brain RT were enrolled on a prospective trial (n = 27). Patients underwent high-resolution volumetric brain magnetic resonance imaging, diffusion-weighted imaging, and neurocognitive testing before and 3, 6, and 12 months post-RT. Medial temporal lobe regions (hippocampus; entorhinal, parahippocampal, and temporal pole white matter [WM]) were autosegmented, quantifying volume and diffusion biomarkers of WM integrity (mean diffusivity [MD]; fractional anisotropy [FA]). Reliable change indices measured changes in verbal (Hopkins Verbal Learning Test-Revised) and visuospatial (Brief Visuospatial Memory Test-Revised [BVMT-R]) memory. Linear mixed-effects models assessed longitudinal associations between imaging parameters and memory. Results: Visuospatial memory significantly declined at 6 months post-RT (mean reliable change indices, –1.3; P = .012). Concurrent chemotherapy and seizures trended toward a significant association with greater decline in visuospatial memory (P = .053 and P = .054, respectively). Higher mean dose to the left temporal pole WM was significantly associated with decreased FA (r = –0.667; P = .002). Over all time points, smaller right hippocampal volume (P = .021), lower right entorhinal FA (P = .023), greater right entorhinal MD (P = .047), and greater temporal pole MD (BVMT-R total recall, P = .003; BVMT-R delayed recall, P = .042) were associated with worse visuospatial memory. The interaction between right entorhinal MD (BVMT-R total recall, P = .021; BVMT-R delayed recall, P = .004) and temporal pole FA (BVMT-R delayed recall, P = .024) significantly predicted visuospatial memory performance. Conclusions: Brain tumor patients exhibited visuospatial memory decline post-RT. Microstructural damage to critical memory regions, including the hippocampus and medial temporal lobe WM, were associated with post-RT memory decline. The integrity of medial temporal lobe structures is critical to memory performance post-RT, representing possible avoidance targets for memory preservation. © 2019 Elsevier Inc.
Keywords: chemotherapy; magnetic resonance imaging; biomarkers; radiotherapy; brain; tumors; quantitative imaging; diffusion weighted imaging; fractional anisotropy; concurrent chemotherapy; methods and materials; linear mixed-effects model; micro-structural damages; quantitative magnetic resonance imaging
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 105
Issue: 4
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2019-11-15
Start Page: 773
End Page: 783
Language: English
DOI: 10.1016/j.ijrobp.2019.08.003
PUBMED: 31408667
PROVIDER: scopus
PMCID: PMC6876859
DOI/URL:
Notes: Source: Scopus
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