Combined functional MRI and tractography assessment of working memory in
survivors of pediatric posterior fossa tumors
Abstract
Pediatric posterior fossa tumors (PFTs) are successfully treated in
approximately 70% of patients. However, most survivors experience
long-term working memory impairment. The present study examined whether
the parameters of diffusion MRI tractography could serve as working
memory impairment biomarkers in 60 pediatric PFT survivors. Participants
were at least 5 years post-treatment and had received treatment
appropriate for their age and type of tumor. Groups included irradiated
PFT had undergone radiotherapy, nonirradiated PFT had not, and age, sex,
and handedness-matched healthy controls. All participants underwent a
cognitive assessment and multimodal MRI including a diffusion MRI
sequence. We combined fMRI data collected from the Human Connectome
Project database with the acquired diffusion MRI data, to extract the
working memory tract and determine tractography parameters for
quantitative insights. Participants in the irradiated PFT group
exhibited reduced tract volume, fiber density, fiber connectivity, mean
length of streamlines, and number of streamlines, compared with both
nonirradiated PFT and control groups. Participants in the nonirradiated
PFT group also exhibited reduced fiber density, number of streamlines,
and mean curvature of streamlines, compared with controls. Poorer
working memory scores for the irradiated PFT group correlated with lower
tract volume, fiber density, and number of streamlines for verbal
working memory. Additionally, these lower scores correlated with reduced
fiber density, mean length of streamlines, and number of streamlines for
visual working memory. These tractography parameters could serve as
biomarkers of working memory deficits and shed light on the detrimental
impact of radiotherapy on the working memory tract.