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

Peng Zhang; Guocan Gu; Yunyun Duan; Zhizheng Zhuo; Changcun Pan; Pengcheng Zuo; Yi Wang; Xiaoou Li; Zhuang Jiang; Liying Qu; Yaou Liu; Liwei Zhang

doi:10.3389/fnins.2022.986873

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

Front Neurosci. 2022 Sep 9:16:986873. doi: 10.3389/fnins.2022.986873. eCollection 2022.

Authors

Peng Zhang¹, Guocan Gu¹, Yunyun Duan², Zhizheng Zhuo², Changcun Pan¹, Pengcheng Zuo¹, Yi Wang¹, Xiaoou Li¹, Zhuang Jiang¹, Liying Qu², Yaou Liu², Liwei Zhang^{1

3

4

5}

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ China National Clinical Research Center for Neurological Diseases, Beijing, China.
⁴ Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
⁵ Beijing Key Laboratory of Brain Tumor, Beijing, China.

Abstract

Background: Previous 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 methods: This 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.

Results: WM 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.

Conclusion: The 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.

Keywords: DKI; brainstem glioma; child; diffusion MRI; tractography; white matter.