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Diffusion tensor imaging indices as biomarkers for cognitive changes following paediatric radiotherapy: a systematic review and meta-analysis

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Abstract

Diffusion tensor imaging (DTI) can detect subtle manifestations of white matter (WM) injury following paediatric radiotherapy, which may be a potential biomarker for cognitive changes. This study aimed to synthesise the relationships between DTI indices and cognitive changes following paediatric radiotherapy through systematic review and meta-analysis. PubMed and Scopus electronic databases were used to identify eligible studies. Quality assessment was performed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information on demographics, DTI changes, and associations to cognitive outcomes were extracted. Meta-analyses were performed on DTI changes in specific anatomical locations. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the preparation of this report. Eighteen studies were included (median study size: 21; range 18–146). 17/18 studies showed significant cognitive decline following irradiation. Meta-analyses found significant cognitive changes within patient’s group of acute lymphoblastic leukaemia (ALL; standard mean differences [SMD] = −0.075, P = 0.01) and brain tumours (BT; SMD = −1.037, P ≤ 0.001) compared to control/baseline. Both groups also had significantly lower fractional anisotropy (FA) scores in the corpus callosum (ALL: SMD = −0.979, P = 0.002; BT: SMD = −1.025, P < 0.001). Decreased FA was consistently associated with cognitive decline. Correlation on WMFA integrity to cognitive domains was statistically significant (Z = 9.86, P < 0.001) with a large effect size (r = 0.52). White matter tract integrity of the corpus callosum measured with FA has the potential to be a biomarker for radiotherapy-related cognitive decline. Inclusion of DTI in follow-up imaging should be encouraged.

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Funding

This work was funded by the Ministry of Higher Learning (Malaysia) – Fundamental Research Grant (FRGS/1/2021/SS03/UKM/02/1) to NY and HAM and the National University of Malaysia under grants FF-2020-013 to HAM, NAY and NSV and GP-2021-K017963 to NAY.

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  1. Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia

    Noor Shatirah Voon & Noorazrul Yahya

  2. Functional Image Processing Laboratory, Department of Radiology, University Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia

    Hanani Abdul Manan

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All authors contributed to the study conception and design. Material preparation, literature search and data analysis were performed by Noor Shatirah Voon, Noorazrul Yahya and Hanani A. Manan. The first draft of the manuscript was written by Noor Shatirah Voon and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Noorazrul Yahya.

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Voon, N.S., Manan, H.A. & Yahya, N. Diffusion tensor imaging indices as biomarkers for cognitive changes following paediatric radiotherapy: a systematic review and meta-analysis. Strahlenther Onkol 198, 409–426 (2022). https://doi.org/10.1007/s00066-022-01905-6

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