Regional brain glucose metabolism and neurocognitive function in adult survivors of childhood cancer treated with cranial radiation

Kevin R. Krull, Satoshi Minoshima, Michelle Edelmann, Brannon Morris, Noah D. Sabin, Tara M. Brinkman, Gregory Armstrong, Leslie L. Robison, Melissa M. Hudson, Barry Shulkin

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Abstract

The objective of this study was to examine associations between regional brain metabolism, as measured by 18F-FDG PET, and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia (ALL) treated with cranial radiation. Method: Thirty-eight adult survivors of ALLwere randomly selected froma large cohort treated with cranial radiation therapy (19 with 18 Gy and 19 with 24 Gy of exposure). At a mean age of 26.4 (range, 22.3-37.4) years, and 23.5 (range, 20.4-32.8) years since diagnosis, patients underwent comprehensive neurocognitive evaluations and brain 18F-FDG PET imaging during a resting condition. 18F-FDG PET images were analyzed stereotactically, and pixel values were normalized to global activity. Predefined region-of-interest and voxel-based correlation analyses were performed. Results: Compared with national norms, survivors demonstrated lower vocabulary (P , 0.001), reading (P , 0.001), mathematics (P , 0.001), working memory (P , 0.001), oral naming speed (P , 0.001), and cognitive flexibility (P , 0.001). Metabolic activity was higher in basal gangliar structures for those treated with 24 Gy of cranial radiation therapy (P 5 0.04). Metabolic activity was positively correlated with oral naming speed in both lateral frontal lobes (ρ 5 0.48 and 0.47 for right and left frontal regions, respectively, P , 0.01) and negatively correlated with cognitive flexibility in the sections of the basal ganglia (P , 0.01 for both caudate and putamen). Conclusion: Neurocognitive impairment in long-term survivors of ALL treated with cranial radiation appears to be associated with increased metabolic activity in frontal cerebral cortical and subcortical regions in the basal ganglia, suggesting decreased efficiency of the frontostriatal brain circuit.

Original languageEnglish (US)
Pages (from-to)1805-1810
Number of pages6
JournalJournal of Nuclear Medicine
Volume55
Issue number11
DOIs
StatePublished - Nov 1 2014

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Survivors
Fluorodeoxyglucose F18
Radiation
Glucose
Brain
Basal Ganglia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Neoplasms
Radiotherapy
Radiation Dosage
Vocabulary
Mathematics
Putamen
Frontal Lobe
Short-Term Memory
Reading
Efficiency

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Krull, K. R., Minoshima, S., Edelmann, M., Morris, B., Sabin, N. D., Brinkman, T. M., ... Shulkin, B. (2014). Regional brain glucose metabolism and neurocognitive function in adult survivors of childhood cancer treated with cranial radiation. Journal of Nuclear Medicine, 55(11), 1805-1810. https://doi.org/10.2967/jnumed.114.142950

Regional brain glucose metabolism and neurocognitive function in adult survivors of childhood cancer treated with cranial radiation. / Krull, Kevin R.; Minoshima, Satoshi; Edelmann, Michelle; Morris, Brannon; Sabin, Noah D.; Brinkman, Tara M.; Armstrong, Gregory; Robison, Leslie L.; Hudson, Melissa M.; Shulkin, Barry.

In: Journal of Nuclear Medicine, Vol. 55, No. 11, 01.11.2014, p. 1805-1810.

Research output: Contribution to journalArticle

Krull, KR, Minoshima, S, Edelmann, M, Morris, B, Sabin, ND, Brinkman, TM, Armstrong, G, Robison, LL, Hudson, MM & Shulkin, B 2014, 'Regional brain glucose metabolism and neurocognitive function in adult survivors of childhood cancer treated with cranial radiation', Journal of Nuclear Medicine, vol. 55, no. 11, pp. 1805-1810. https://doi.org/10.2967/jnumed.114.142950
Krull, Kevin R. ; Minoshima, Satoshi ; Edelmann, Michelle ; Morris, Brannon ; Sabin, Noah D. ; Brinkman, Tara M. ; Armstrong, Gregory ; Robison, Leslie L. ; Hudson, Melissa M. ; Shulkin, Barry. / Regional brain glucose metabolism and neurocognitive function in adult survivors of childhood cancer treated with cranial radiation. In: Journal of Nuclear Medicine. 2014 ; Vol. 55, No. 11. pp. 1805-1810.
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abstract = "The objective of this study was to examine associations between regional brain metabolism, as measured by 18F-FDG PET, and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia (ALL) treated with cranial radiation. Method: Thirty-eight adult survivors of ALLwere randomly selected froma large cohort treated with cranial radiation therapy (19 with 18 Gy and 19 with 24 Gy of exposure). At a mean age of 26.4 (range, 22.3-37.4) years, and 23.5 (range, 20.4-32.8) years since diagnosis, patients underwent comprehensive neurocognitive evaluations and brain 18F-FDG PET imaging during a resting condition. 18F-FDG PET images were analyzed stereotactically, and pixel values were normalized to global activity. Predefined region-of-interest and voxel-based correlation analyses were performed. Results: Compared with national norms, survivors demonstrated lower vocabulary (P , 0.001), reading (P , 0.001), mathematics (P , 0.001), working memory (P , 0.001), oral naming speed (P , 0.001), and cognitive flexibility (P , 0.001). Metabolic activity was higher in basal gangliar structures for those treated with 24 Gy of cranial radiation therapy (P 5 0.04). Metabolic activity was positively correlated with oral naming speed in both lateral frontal lobes (ρ 5 0.48 and 0.47 for right and left frontal regions, respectively, P , 0.01) and negatively correlated with cognitive flexibility in the sections of the basal ganglia (P , 0.01 for both caudate and putamen). Conclusion: Neurocognitive impairment in long-term survivors of ALL treated with cranial radiation appears to be associated with increased metabolic activity in frontal cerebral cortical and subcortical regions in the basal ganglia, suggesting decreased efficiency of the frontostriatal brain circuit.",
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AU - Krull, Kevin R.

AU - Minoshima, Satoshi

AU - Edelmann, Michelle

AU - Morris, Brannon

AU - Sabin, Noah D.

AU - Brinkman, Tara M.

AU - Armstrong, Gregory

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

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N2 - The objective of this study was to examine associations between regional brain metabolism, as measured by 18F-FDG PET, and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia (ALL) treated with cranial radiation. Method: Thirty-eight adult survivors of ALLwere randomly selected froma large cohort treated with cranial radiation therapy (19 with 18 Gy and 19 with 24 Gy of exposure). At a mean age of 26.4 (range, 22.3-37.4) years, and 23.5 (range, 20.4-32.8) years since diagnosis, patients underwent comprehensive neurocognitive evaluations and brain 18F-FDG PET imaging during a resting condition. 18F-FDG PET images were analyzed stereotactically, and pixel values were normalized to global activity. Predefined region-of-interest and voxel-based correlation analyses were performed. Results: Compared with national norms, survivors demonstrated lower vocabulary (P , 0.001), reading (P , 0.001), mathematics (P , 0.001), working memory (P , 0.001), oral naming speed (P , 0.001), and cognitive flexibility (P , 0.001). Metabolic activity was higher in basal gangliar structures for those treated with 24 Gy of cranial radiation therapy (P 5 0.04). Metabolic activity was positively correlated with oral naming speed in both lateral frontal lobes (ρ 5 0.48 and 0.47 for right and left frontal regions, respectively, P , 0.01) and negatively correlated with cognitive flexibility in the sections of the basal ganglia (P , 0.01 for both caudate and putamen). Conclusion: Neurocognitive impairment in long-term survivors of ALL treated with cranial radiation appears to be associated with increased metabolic activity in frontal cerebral cortical and subcortical regions in the basal ganglia, suggesting decreased efficiency of the frontostriatal brain circuit.

AB - The objective of this study was to examine associations between regional brain metabolism, as measured by 18F-FDG PET, and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia (ALL) treated with cranial radiation. Method: Thirty-eight adult survivors of ALLwere randomly selected froma large cohort treated with cranial radiation therapy (19 with 18 Gy and 19 with 24 Gy of exposure). At a mean age of 26.4 (range, 22.3-37.4) years, and 23.5 (range, 20.4-32.8) years since diagnosis, patients underwent comprehensive neurocognitive evaluations and brain 18F-FDG PET imaging during a resting condition. 18F-FDG PET images were analyzed stereotactically, and pixel values were normalized to global activity. Predefined region-of-interest and voxel-based correlation analyses were performed. Results: Compared with national norms, survivors demonstrated lower vocabulary (P , 0.001), reading (P , 0.001), mathematics (P , 0.001), working memory (P , 0.001), oral naming speed (P , 0.001), and cognitive flexibility (P , 0.001). Metabolic activity was higher in basal gangliar structures for those treated with 24 Gy of cranial radiation therapy (P 5 0.04). Metabolic activity was positively correlated with oral naming speed in both lateral frontal lobes (ρ 5 0.48 and 0.47 for right and left frontal regions, respectively, P , 0.01) and negatively correlated with cognitive flexibility in the sections of the basal ganglia (P , 0.01 for both caudate and putamen). Conclusion: Neurocognitive impairment in long-term survivors of ALL treated with cranial radiation appears to be associated with increased metabolic activity in frontal cerebral cortical and subcortical regions in the basal ganglia, suggesting decreased efficiency of the frontostriatal brain circuit.

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