T2 FLAIR Hyperintensity Volume Is Associated With Cognitive Function and Quality of Life in Clinically Stable Patients With Lower Grade Gliomas

Abstract

Survival outcomes for patients with lower grade gliomas (LrGG) continue to improve. However, damage caused both by tumor growth and by the consequences of treatment often leads to significantly impaired cognitive function and quality of life (QoL). While neuropsychological testing is not routine, serial clinical MRIs are standard of care for patients with LrGG. Thus, having a greater understanding of MRI indicators of cognitive and QoL impairment risk could be beneficial to patients and clinicians. In this work we sought to test the hypothesis that in clinically stable LrGG patients, T2 FLAIR hyperintensity volumes at the time of cognitive assessment are associated with impairments of cognitive function and QoL and could be used to help identify patients for cognitive and QoL assessments and interventions. We performed anatomical MR imaging, cognitive testing and QoL assessments cross-sectionally in 30 clinically stable grade 2 and 3 glioma patients with subjective cognitive concerns who were 6 or more months post-treatment. Larger post-surgical T2 FLAIR volume at testing was significantly associated with lower cognitive performance, while pre-surgical tumor volume was not. Older patients had lower cognitive performance than younger patients, even after accounting for normal age-related declines in performance. Patients with Astrocytoma, IDH mutant LrGGs were more likely to show lower cognitive performance than patients with Oligodendroglioma, IDH mutant 1p19q co-deleted LrGGs. Previous treatment with combined radiation and chemotherapy was associated with poorer self-reported QoL, including self-reported cognitive function. This study demonstrates the importance of appreciating that LrGG patients may experience impairments in cognitive function and QoL over their disease course, including during periods of otherwise sustained clinical stability. Imaging factors can be helpful in identifying vulnerable patients who would benefit from cognitive assessment and rehabilitation.

Keywords: cognition; glioma; neuro-oncology; neuroimaging; neuropsychology.

Figure 1

(A) Example of tumor volume defined by hyperintensity on T2 FLAIR MR images. (B) Mean age-corrected cognition scores from the NIH Toolbox, which has a healthy control mean of 100 and standard deviation of 10 (indicated by the gray box). (C) Mean age-corrected cognition subscores from the NIH Toolbox by T2 FLAIR tumor volume at the time of cognitive testing, *p < 0.05, corrected for multiple comparisons. (D) Mean age-corrected cognition summary scores from the NIH Toolbox by T2 FLAIR tumor volume at the time of cognitive testing, *p < 0.05, corrected for multiple comparisons.

Figure 2

(A) Mean age-corrected cognition subscores from the NIH Toolbox by patient age, *p < 0.05, corrected for multiple comparisons. (B) Mean age-corrected cognition summary scores from the NIH Toolbox by WHO 2021 molecular diagnostic subgroup, *p 0.05, corrected for multiple comparisons. (C) Mean FACT-BR cognition subscore, FACT-BR Total score by patient radiation and chemotherapy history, *p < 0.05, corrected for multiple comparisons.