Limited Research Investigating the Added Value of MRI in Predicting Future Cognitive Morbidity in Survivors of Paediatric Brain Tumours: A Call to Action for Clinical Neuroimaging Researchers

Survivors of pediatric brain tumour patients are at high risk of cognitive morbidity. There is clinical benefit in being able to reliably predict, at the individual patient level, whether a patient will experience these difficulties or not, the degree of impairment, and the domains affected. Whilst established risk factors exist, quantitative analysis of MRI could provide added predictive value towards this goal, above and beyond existing clinical risk models. The current systematic review aims to answer the question; Do MRI markers predict future cognitive functioning in pediatric brain tumour survivors?. Studies of pediatric brain tumour patients which test the value of MRI variables in predicting later neuropsychological outcomes were searched up to July 2022. Only included were studies where MRI scans were acquired at an earlier timepoint and used to predict a child's performance on cognitive tests at a later timepoint. Surprisingly few studies were identified by the search process which specifically investigated MRI measures of cerebellar and white matter damage as features in predicting cognitive outcomes. However, the important finding of this review is that the current literature is limited and those identified had small sample sizes and were rated as poor quality for the purposes of prediction. Overall, current findings are at high risk of bias and thus the quality and impact of conclusions are limited. Given the significant impact for this clinical population that predictive models would enable, the current review affirms the need for a call-to-action for medical imaging researchers in pediatric neuro-oncology.