Serial MRI Scan of Posterior Fossa Tumours Predict Patients at Risk of Developing Neurocognitive Impairment

Background: Brain tumours are the most common solid tumours in children. More than 50% of these tumours develop in the posterior cranial fossa. Long term survivors of posterior fossa tumours (PFT) suffer from neurocognitive and memory issues. We hypothesized that serial MRI scanning of brain would show differences in hippocampal and ACC volume change in PFT patients treated with and without chemo-radiotherapy. Material and Methods: Twelve patients (8 females and 4 males) underwent 76 serial MR imaging examinations before and during treatment for posterior fossa tumours. Seven patients (4 medulloblastoma, 2 as ependymoma and 1 high grade glioma) were treated with maximum surgical resection followed by adjuvant radiotherapy and chemotherapy (Group 1). The other five patients were diagnosed as pilocytic astrocytoma who were treated only with surgery (Group 2). Hippocampal volumes were obtained manually on high-resolution 3Tesla T1-weighted images and normalised to intracranial volume, while ACC thickness and volume were obtained automatically using FreeSurfer software. Results: After the treatment period, the change in normalised hippocampal volume from baseline was significantly lower in group 1 patients compared to group 2 (mean change -0.0001470 ± 8.981e-005; Mean ± SEM vs 0.0002765 ± 9.151e-005; Mean ± SEM, respectively, P=0.004). Displayed graphically, the negative hippocampal growth trajectory in group 1 gradually returned to a positive growth pattern. There were no statistically significant changes in ACC volume and thickness. Both groups had similar rates of pre-operative hydrocephalus. Conclusion: Compared to PFT patients treated with surgery alone, PFT patients treated with chemo-radiotherapy showed lower hippocampal volumes and altered hippocampal growth trajectory. Serial quantitative MRI measures of brain may provide a neuroanatomical substrate for assessing functional impact on normal brain function following treatment of posterior fossa tumours.