Diffusion Tensor Imaging Study of Cognitive Dysfunction After Radiochemotherapy for Frontal Lobe Glioma

Diffusion Tensor Imaging Study of Cognitive Dysfunction After Radiochemotherapy for Frontal Lobe Glioma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diffusion Tensor Imaging Study of Cognitive Dysfunction After Radiochemotherapy for Frontal Lobe Glioma Jia Chen, Xiaoping Li, Zhi Tian, Chunhai Huang, Yi Wan, Zhao Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9225199/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective To investigate the structural basis of white matter fiber tracts in cognitive dysfunction following radiochemotherapy in patients with frontal lobe glioma. Methods A total of 40 patients with frontal lobe glioma who underwent surgery and postoperative concurrent radiochemotherapy in First Affiliated Hospital of Jishou University from June 2023 to June 2025 were enrolled. Montreal Cognitive Assessment (MoCA) and diffusion tensor imaging (DTI) were performed at three time points: preoperative (T0), 1 month postoperative (T1), and 6 months post-radiochemotherapy (T2). Fiber tractography was used to extract fractional anisotropy (FA) and mean diffusivity (MD) values of the superior longitudinal fasciculus (SLF), cingulum (Cg), corpus callosum (CC), uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), and corticospinal tract (CST). Cognitive scores and DTI parameters were compared across time points, and correlations between changes in key fiber tract parameters and changes in MoCA total score and cognitive domain scores were analyzed. Results MoCA total scores differed significantly across time points (F = 4.892, P = 0.009), with scores at T2 being lower than those at T1 and T0. Visuospatial/executive function and delayed recall showed statistically significant overall differences across time points, but after Bonferroni correction, pairwise comparisons did not reach statistical significance (P > 0.0167), only suggesting a declining trend. FA values of the SLF, Cg, and CC showed significant differences across the three time points, with significant decreases at T2 compared with T1; MD values of the SLF and CC also showed significant differences across time points, with significant increases at T2 compared with T1. FA and MD values of the UF, IFOF, AF, and CST showed no significant differences across time points. Correlation analysis showed that ΔFA of the CC was positively correlated with ΔMoCA total score, ΔFA of the SLF was positively correlated with changes in visuospatial/executive function scores, and ΔFA of the Cg was positively correlated with changes in delayed recall scores; ΔMD of each fiber tract showed no significant correlations with changes in MoCA total score or cognitive domain scores. Conclusion Cognitive dysfunction after radiochemotherapy for frontal lobe glioma is closely associated with damage to cognitive-related white matter connection networks, predominantly involving the SLF (executive function), Cg (memory function), and CC (overall cognitive function). Glioma Frontal lobe Radiochemotherapy Cognitive dysfunction Diffusion tensor imaging White matter fiber tracts Figures Figure 1 Figure 2 Figure 3 Figure 4 1 Introduction Patients with frontal lobe glioma often present with varying degrees of cognitive impairment [ 1 – 3 ]. With the continuous improvement in comprehensive treatment modalities combining surgery with radiochemotherapy, patient survival has been prolonged; however, the occurrence of cognitive dysfunction has become a critical factor affecting patients‘ quality of life [ 4 – 7 ]. Diffusion tensor imaging (DTI) can sensitively detect microstructural changes in cerebral white matter fiber tracts [ 8 , 9 ], yet existing studies have predominantly focused on the corticospinal tract related to motor function [ 10 – 12 ], with a lack of longitudinal dynamic assessments targeting cognitive-related white matter fiber tracts. Therefore, this study employs DTI fiber tractography to longitudinally monitor microstructural changes in cognitive-related white matter fiber tracts in patients with frontal lobe glioma before and after radiochemotherapy, and to explore their correlation with cognitive impairment, aiming to elucidate the structural basis of post-radiochemotherapy cognitive injury at the level of white matter connection networks, and to provide imaging evidence for early identification of high-risk populations and the development of individualized protective strategies in clinical practice. 2 Materials and Methods 2.1 Study Participants Patients with frontal lobe glioma treated at The First Affiliated Hospital of Jishou University (Xiangxi Tujia and Miao Autonomous Prefecture People’s Hospital) from June 2023 to June 2025 were retrospectively enrolled. This study was approved by the Ethics Committee of The First Affiliated Hospital of Jishou University (Approval No. XXZRY-LCKY-2025-16). Due to the retrospective design and the use of anonymized data with minimal risk to patients, the Ethics Committee waived the requirement for written informed consent. Inclusion criteria: (1) Age 18–70 years; (2) Pathologically confirmed frontal lobe glioma (WHO grade 2–4) after surgery; (3) First surgical treatment followed by concurrent radiochemotherapy; (4) Completed MRI examination and cognitive assessment at preoperative, 1 month postoperative, and 6 months post-radiochemotherapy; (5) Right-handed; (6) Education duration ≥ 6 years and able to cooperate with cognitive assessment. Exclusion criteria: (1) Bilateral frontal lobe or multiple lesions; (2) Previous history of cranial radiotherapy; (3) Recurrence or progression of intracranial tumor; (4) Severe mental illness, uncontrolled epilepsy, Alzheimer's disease, or other conditions affecting cognitive function; (5) Contraindications to MRI (e.g., cardiac pacemaker, metallic implants, severe claustrophobia); (6) Pregnant or lactating women; (7) Occurrence of traumatic brain injury, cerebrovascular accident, or other events that may affect the accuracy of cognitive assessment during follow-up. 2.2 Treatment Protocol All patients underwent microscopic resection of frontal lobe glioma. MRI was performed within 72 hours after surgery to evaluate the extent of resection, which was classified as complete resection (no significant residual tumor) or partial resection (residual tumor present). Postoperative adjuvant treatment was formulated according to the pathological grade and molecular pathology findings, following the Guidelines for the Diagnosis and Treatment of Glioma [ 13 , 14 ]. Radiotherapy was delivered using intensity-modulated radiotherapy (IMRT). The total radiation dose ranged from 45 to 60 Gy, with a fractionated dose of 1.8–2.0 Gy per fraction, 5 fractions per week, prescribed according to tumor grade and molecular pathology. Concurrent chemotherapy was administered using temozolomide (TMZ) at 75 mg/(m²·d). After radiotherapy, adjuvant chemotherapy was given with TMZ at a dose of 150–200 mg/(m²·d) for 5 consecutive days, repeated every 28 days, for a total of 6 cycles. 2.3 Cognitive Assessment Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) in all patients. Assessments were performed at three time points: preoperative (T0), 1 month postoperative (T1), and 6 months post-radiochemotherapy (T2). The MoCA scale encompasses seven cognitive domains: visuospatial/executive function, naming, attention, language, abstraction, delayed recall, and orientation, with a total score of 30 points. For patients with education duration ≤ 12 years, one point was added to the total score (original maximum 30 points, maximum after adjustment 31 points). All assessments were conducted by uniformly trained physicians in a quiet environment on a one-to-one basis, and whenever possible, the same physician performed the assessments at each time point to minimize evaluation bias. 2.4 MRI Data Acquisition MRI was performed using a Siemens 3.0T scanner (MAGNETOM Verio, Siemens Healthcare, Germany) with a 32-channel head coil. The scanning sequences and parameters were as follows: (1) Conventional MRI: T1-weighted imaging (T1WI: TR 250 ms, TE 2.5 ms), T2-weighted imaging (T2WI: TR 4000 ms, TE 95 ms), and fluid-attenuated inversion recovery (FLAIR: TR 8000 ms, TE 95 ms, TI 2200 ms). Slice thickness was 5 mm with a 1 mm interslice gap, and the matrix was 256 × 256. (2) 3D-T1 structural imaging: Magnetization-prepared rapid gradient echo (MPRAGE) sequence with TR 1900 ms, TE 2.5 ms, TI 900 ms, flip angle 9°, slice thickness 1.0 mm with no gap, matrix 256 × 256, and voxel size 1.0 mm × 1.0 mm × 1.0 mm. (3) Diffusion tensor imaging (DTI): Single-shot spin echo echo-planar imaging (SE-EPI) sequence with TR 8000 ms, TE 95 ms, flip angle 90°, slice thickness 2.0 mm with no gap, matrix 128 × 128, and voxel size 2.0 mm × 2.0 mm × 2.0 mm. Diffusion-sensitizing gradients were applied in 30 directions with b-values of 0 and 1000 s/mm². 2.5 DTI Data Processing and Analysis 2.5.1 Data Preprocessing DTI data were processed and analyzed using DSI Studio (Version 2025, http://dsi-studio.labsolver.org ) [ 15 ]. Raw DICOM data were first converted to SRC format, followed by motion correction and eddy current correction. Subsequently, the generalized q-sampling imaging (GQI) algorithm was employed for reconstruction to enable whole-brain fiber tractography. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted as the primary analytical metrics. 2.5.2 Fiber Tractography Deterministic fiber tracking based on quantitative anisotropy (QA) was performed for whole-brain fiber tract reconstruction. The tracking parameters were set as follows: QA threshold 0.1, angle threshold 45°, step length 1.0 mm, and fiber length threshold 20–300 mm. Based on the ICBM-DTI-81 white matter atlas[ 16 ], the following fiber tracts of interest were extracted using an automated fiber tract identification method: (1) superior longitudinal fasciculus (SLF); (2) cingulum (Cg); (3) corpus callosum (CC); (4) uncinate fasciculus (UF); (5) inferior fronto-occipital fasciculus (IFOF); (6) arcuate fasciculus (AF); and (7) corticospinal tract (CST), which served as a negative control. Each extracted fiber tract was visually inspected to ensure accurate anatomical localization. 2.5.3 Fiber Tract Parameter Extraction and Calculation After reconstructing the target fiber tracts using fiber tractography, the mean fractional anisotropy (FA) and mean diffusivity (MD) of each fiber tract were extracted at the whole-tract level. The changes in DTI parameters for each fiber tract were calculated as follows: ΔFA = T2 FA − T1 FA, ΔMD = T2 MD − T1 MD. 2.6 Statistical Analysis Statistical analyses were performed using SPSS 26.0 software (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (x̄ ± s), and categorical variables were presented as counts (%). Repeated measures analysis of variance was used to compare cognitive scores and DTI parameters across the three time points (T0, T1, T2), with pairwise comparisons adjusted using the Bonferroni correction. Pearson correlation analysis or Spearman rank correlation analysis was employed to evaluate the associations between changes in DTI parameters (ΔFA, ΔMD) of key fiber tracts and changes in MoCA total scores as well as scores in each cognitive domain. A P-value < 0.05 was considered statistically significant. 2.7 Ethics Statement This retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of The First Affiliated Hospital of Jishou University (Approval No. XXZRY-LCKY-2025-16). The Ethics Committee waived the requirement for informed consent because: (1) the study posed minimal risk; (2) all data were analyzed anonymously from existing medical records; (3) no additional interventions were performed; and (4) obtaining consent was impracticable due to the retrospective design. All patient data were de-identified prior to analysis to ensure confidentiality. 3 Results 3.1 Demographic and Clinical Characteristics A total of 40 patients with frontal lobe glioma were enrolled in this study, including 21 males (52.5%) and 19 females (47.5%). The mean age was 50.28 ± 13.52 years (range, 21–70 years). Regarding educational level, 18 patients (45.0%) had primary school education, 15 (37.5%) had secondary school education, and 7 (17.5%) had college education or above. Tumors were located in the left frontal lobe in 22 cases (55.0%) and in the right frontal lobe in 18 cases (45.0%). According to WHO grade, there were 14 cases (35.0%) of grade II, 12 cases (30.0%) of grade III, and 14 cases (35.0%) of grade IV. Complete resection was achieved in 26 patients (65.0%), while partial resection was performed in 14 patients (35.0%). All patients received intensity-modulated radiotherapy (IMRT), with a mean radiation dose of 57.23 ± 2.86 Gy. The mean radiation dose was 57.85 ± 2.71 Gy in the cognitive decline group and 56.82 ± 2.93 Gy in the cognitive stable group. The preoperative MoCA score was 25.33 ± 2.18, and the 1-month postoperative MoCA score was 25.15 ± 2.43. The mean preoperative tumor volume was 38.52 ± 16.73 cm³. Based on the change in MoCA score at 6 months post-radiochemotherapy compared with that at 1 month postoperatively, patients were divided into a cognitive decline group (decline ≥ 2 points, n = 16) and a cognitive stable group (decline < 2 points or score improvement, n = 24). No significant differences were observed between the two groups in terms of age, sex, educational level, tumor laterality, WHO grade, radiotherapy modality, radiation dose, preoperative or 1-month postoperative MoCA scores, or preoperative tumor volume ( P > 0.05), indicating comparability between the groups. A statistically significant difference was found in the extent of resection between the two groups (χ² = 5.253, P = 0.022): the proportion of patients with partial resection was 56.3% (9/16) in the cognitive decline group, which was higher than that in the cognitive stable group (20.8%, 5/24), suggesting that patients with partial resection were more likely to experience cognitive decline after radiochemotherapy(Table 1 ). Table 1 Demographic and clinical characteristics of the study participants Characteristic Overall(n = 40) Cognitive decline group (n = 16) Cognitive stable group (n = 24) Statistic P value Age(year, xˉ±s) 50.28 ± 13.52 51.63 ± 12.87 49.38 ± 14.06 t = 0.524 0.603 Sex〔n(%)〕 χ2 = 0.157 0.692 Male 21 (52.5) 9 (56.3) 12 (50.0) Female 19 (47.5) 7 (43.7) 12 (50.0) Education 〔n(%)〕 χ2 = 0.590 0.745 Primary school 18 (45.0) 7 (43.7) 11 (45.8) Secondary school 15 (37.5) 7 (43.7) 8 (33.3) College or above 7 (17.5) 2 (12.5) 5 (20.8) Tumor laterality〔n(%)〕 χ2 = 0.615 0.433 Left 22 (55.0) 10 (62.5) 12 (50.0) Right 18 (45.0) 6 (37.5) 12 (50.0) WHO grade 〔n(%)〕 χ2 = 1.956 0.376 Grade 2 14 (35.0) 4 (25.0) 10 (41.6) Grade 3 12 (30.0) 5 (31.3) 7 (29.2) Grade 4 14 (35.0) 7 (43.7) 7 (29.2) Extent of resection 〔n(%)〕 χ2 = 5.253 0.022 Complete resection 26 (65.0) 7 (43.7) 19 (79.2) Partial resection 14 (35.0) 9 (56.3) 5 (20.8) Radiation dose(Gy, xˉ±s) 57.23 ± 2.86 57.85 ± 2.71 56.82 ± 2.93 t = 1.024 0.311 Preoperative MoCA score(xˉ±s) 25.33 ± 2.18 24.81 ± 2.07 25.67 ± 2.21 t = 1.244 0.221 1-month postoperative MoCA score(xˉ±s) 25.15 ± 2.43 24.63 ± 2.34 25.50 ± 2.48 t = 1.121 0.269 Preoperative tumor volume(cm³, xˉ±s) 38.52 ± 16.73 39.85 ± 16.98 37.45 ± 15.62 t = 0.763 0.450 Table 2 Comparison of cognitive function scores before and after radiochemotherapy((x̄ ± s, points) Cognitive domain Preoperative(T0) 1-month postoperative(T1) 6-month post-radiochemotherapy(T2) F value P value Pairwise comparisons a MoCA 25.33 ± 2.18 25.15 ± 2.43 23.68 ± 2.87 4.892 0.009 T2 < T1 ∗ , T2 < T0 # Visuospatial/executive function 4.12 ± 0.85 4.05 ± 0.92 3.58 ± 1.06 3.845 0.025 - Naming 2.85 ± 0.36 2.83 ± 0.38 2.78 ± 0.42 0.367 0.694 - Attention 5.23 ± 0.78 5.18 ± 0.84 4.95 ± 0.91 1.234 0.296 - Language 2.45 ± 0.64 2.45 ± 0.64 2.18 ± 0.73 1.892 0.156 - Abstraction 1.58 ± 0.50 1.55 ± 0.51 1.55 ± 0.51 0.134 0.875 - Delayed recall 3.62 ± 0.92 3.58 ± 0.98 3.08 ± 1.12 3.456 0.036 - Orientation 5.48 ± 0.64 5.45 ± 0.68 5.38 ± 0.72 0.223 0.801 - Note: a Pairwise comparisons were performed using the Bonferroni correction with a significance level set at α′=0.05/3 = 0.0167. ∗ P < 0.0167 compared with T1; # P < 0.0167 compared with T0. Bold values indicate statistical significance in the overall repeated measures ANOVA ( P < 0.05). 3.2 Comparison of Cognitive Function Before and After Radiochemotherapy Repeated measures ANOVA revealed a statistically significant difference in MoCA total scores across the three time points (F = 4.892, P = 0.009) (Fig. 1 B ) . After Bonferroni correction, the MoCA total score at T2 was significantly lower than those at T1 and T0, indicating a significant decline in overall cognitive function at 6 months post-radiochemotherapy compared with both preoperative and 1-month postoperative levels. Among the cognitive domains, visuospatial/executive function (F = 3.845, P = 0.025) and delayed recall (F = 3.456, P = 0.036) showed statistically significant overall differences across time points; however, after Bonferroni correction, pairwise comparisons did not reach statistical significance ( P > 0.0167), only suggesting a declining trend. No significant differences were observed across the three time points for language (F = 1.892, P = 0.156), attention (F = 1.234, P = 0.296), naming (F = 0.367, P = 0.694), abstraction (F = 0.134, P = 0.875), or orientation (F = 0.223, P = 0.801) (Fig. 1 A ). Overall, patients with frontal lobe glioma exhibited a decline in global cognitive function at 6 months after radiochemotherapy, with executive function and memory function showing more pronounced trends of impairment. (A) MoCA domain scores (bar chart). Scores of seven cognitive domains at T0 (blue), T1 (orange), and T2 (green). Visuospatial/executive function and delayed recall showed declining trends at T2 (†). Error bars: SD. (B) MoCA total scores (line chart). Total MoCA score (0–30) decreased significantly at T2 vs T1 and T0 (* P < 0.0167, Bonferroni correction). 3.3 Comparison of DTI Parameters in Key Fiber Tracts Before and After Radiochemotherapy Repeated measures ANOVA revealed heterogeneity in the changes of DTI parameters across different fiber tracts. The specific results are as follows. Superior longitudinal fasciculus (SLF): FA values showed statistically significant differences across time points (F = 5.234, P = 0.007). After Bonferroni correction, FA values at T2 (0.423 ± 0.045) were lower than those at T1 (0.448 ± 0.041) and T0 (0.452 ± 0.038). MD values also showed statistically significant differences across time points (F = 4.567, P = 0.013), with MD values at T2 [(0.768 ± 0.048 )× 10⁻³ mm²/s ]being higher than those at T1 [(0.742 ± 0.045) × 10⁻³ mm²/s]. Cingulum (Cg): FA values showed statistically significant differences across time points (F = 4.892, P = 0.010), with FA values at T2 (0.438 ± 0.047) being lower than those at T1 (0.465 ± 0.044). MD values also showed statistically significant differences across time points (F = 4.234, P = 0.018); however, after Bonferroni correction, pairwise comparisons did not reach statistical significance, only suggesting an increasing trend. Corpus callosum (CC): FA values showed statistically significant differences across time points (F = 5.156, P = 0.008), with FA values at T2 (0.478 ± 0.053) being lower than those at T1 (0.508 ± 0.050) and T0 (0.512 ± 0.048). MD values also showed statistically significant differences across time points (F = 4.892, P = 0.010), with MD values at T2[ (0.728 ± 0.044 )× 10⁻³ mm²/s] being higher than those at T1 [(0.702 ± 0.041) × 10⁻³ mm²/s] (Fig. 2 ). Uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), and arcuate fasciculus (AF): No statistically significant differences were observed in either FA or MD values across time points ( P > 0.05), indicating no clear microstructural changes within 6 months after radiochemotherapy. Corticospinal tract (CST), serving as a negative control, showed no statistically significant differences in either FA or MD values across time points ( P > 0.05), consistent with expectations. (A) Fractional anisotropy (FA). FA values decreased significantly at T2 in the SLF, Cg, and CC (* P < 0.0167, Bonferroni correction), indicating reduced white matter integrity. (B) Mean diffusivity (MD). MD values increased significantly at T2 in the SLF and CC (* P < 0.0167), suggesting demyelination or microstructural damage. 3.4 Correlation Between DTI Parameter Changes in Fiber Tracts and Cognitive Function Changes The change in FA (ΔFA) of the corpus callosum (CC) was significantly positively correlated with the change in MoCA total score (ΔMoCA) (r = 0.593, P = 0.003), indicating that a greater decrease in CC FA was associated with a more pronounced decline in global cognitive function. The change in FA of the superior longitudinal fasciculus (SLF) was significantly positively correlated with the change in executive function (change in visuospatial/executive function score) (r = 0.364, P = 0.007), suggesting that the degree of SLF damage was closely associated with the magnitude of executive function decline. The change in FA of the cingulum (Cg) was significantly positively correlated with the change in memory function (change in delayed recall score) (r = 0.349, P = 0.012), indicating a specific association between microstructural damage of the cingulum and memory function decline. No significant correlations were found between ΔMD of any fiber tract and changes in MoCA total score or cognitive domain scores ( P > 0.05). Figure 3 . Furthermore, no significant correlations were observed between DTI parameter changes of the uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), or arcuate fasciculus (AF) and changes in any cognitive domain ( P > 0.05), consistent with the absence of significant DTI parameter changes for these tracts. The corticospinal tract (CST), serving as a negative control, showed no correlations between its DTI parameter changes and any cognitive domain ( P > 0.05), as expected. These findings suggest that cognitive dysfunction after radiochemotherapy exhibits fiber tract specificity: CC damage is primarily associated with global cognitive decline, SLF damage with executive function decline, and Cg damage with memory function decline. A: Correlation between FA change in the corpus callosum and change in cognitive function, r = 0.593, P = 0.003; B: Correlation between FA change in the superior longitudinal fasciculus and change in executive function, r = 0.364, P = 0.007; C: Correlation between FA change in the cingulum and change in memory function, r = 0.349, P = 0.012. 3.5 Visualization of White Matter Fiber Tract Reconstruction To provide visual representation of the white matter fiber tract changes before and after radiochemotherapy, Fig. 4 illustrates three-dimensional reconstructions of frontal lobe-associated white matter fiber tracts. Figure 2 A shows a schematic diagram of normal frontal lobe gross anatomy. Figure 2 B presents three-dimensional reconstruction of normal frontal lobe white matter fiber tracts, demonstrating the typical morphology of key fiber bundles including the superior longitudinal fasciculus (SLF), cingulum (Cg), and corpus callosum (CC). Figures 2 C and 2 D compare three-dimensional reconstructions of frontal lobe white matter fiber tracts in a representative patient before and after radiotherapy, respectively. Morphological changes, including fiber tract thinning and reduced fiber density, can be observed following radiotherapy, consistent with the microstructural alterations reflected by decreased FA values in the SLF, Cg, and CC reported in Table 3 . Table 3 Comparison of DTI parameters in key fiber tracts before and after radiochemotherapy (xˉ±s) Fiber tract Parameter Preoperative (T0) 1-month postoperative (T1) 6-month post-radiochemotherapy (T2) F value P value Pairwise Comparisons a Superior longitudinal fasciculus (SLF) FA 0.452 ± 0.038 0.448 ± 0.041 0.423 ± 0.045 5.234 0.007 T2 < T1∗, T2 T1∗ Cingulum (Cg) FA 0.468 ± 0.042 0.465 ± 0.044 0.438 ± 0.047 4.892 0.010 T2 < T1∗ MD 0.724 ± 0.040 0.728 ± 0.043 0.756 ± 0.046 4.234 0.018 - Corpus callosum (CC) FA 0.512 ± 0.048 0.508 ± 0.050 0.478 ± 0.053 5.156 0.008 T2 < T1∗, T2 T1∗ Uncinate fasciculus (UF) FA 0.412 ± 0.040 0.410 ± 0.042 0.398 ± 0.045 1.234 0.296 - MD 0.768 ± 0.045 0.772 ± 0.047 0.784 ± 0.050 1.156 0.32 - Inferior fronto-occipital fasciculus (IFOF) FA 0.435 ± 0.041 0.432 ± 0.043 0.422 ± 0.046 1.892 0.157 - MD 0.752 ± 0.043 0.756 ± 0.045 0.768 ± 0.048 1.567 0.214 - Arcuate fasciculus (AF) FA 0.442 ± 0.039 0.440 ± 0.041 0.428 ± 0.044 2.134 0.124 - MD 0.742 ± 0.041 0.745 ± 0.043 0.758 ± 0.046 1.789 0.174 - Corticospinal tract (CST) FA 0.528 ± 0.046 0.526 ± 0.047 0.524 ± 0.048 0.234 0.792 - MD 0.682 ± 0.036 0.684 ± 0.038 0.686 ± 0.040 0.156 0.856 - Note: a Pairwise comparisons were performed using the Bonferroni correction with a significance level set at α′=0.05/3 = 0.0167. ∗ P < 0.0167 compared with T1; # P < 0.0167 compared with T0. b MD Unit:×10⁻³ mm²/s。 Bold values indicate statistical significance in the overall repeated measures ANOVA ( P < 0.05). A: Schematic diagram of gross anatomy of the normal frontal lobe; B: Three-dimensional reconstruction of white matter fiber tracts associated with the normal frontal lobe; C: Three-dimensional reconstruction of white matter fiber tracts associated with the frontal lobe in a patient with frontal lobe glioma before radiotherapy; D: Three-dimensional reconstruction of white matter fiber tracts associated with the frontal lobe in the same patient after radiotherapy. Morphological differences in the frontal lobe-associated white matter fiber tracts can be observed before and after radiotherapy. 4 Discussion With the continuous advancement of comprehensive treatment strategies for glioma, patient survival has gradually extended; consequently, treatment-related cognitive dysfunction has become a critical factor affecting long-term quality of life and social functional recovery [ 3 , 5 , 17 ]. In this study, we employed DTI fiber tractography to longitudinally evaluate cognitive-related white matter fiber tracts in patients with frontal lobe glioma before and after radiochemotherapy. The results showed that MoCA total scores at 6 months after radiochemotherapy were significantly lower than those before surgery and at 1 month postoperatively. At the white matter fiber tract level, microstructural damage was observed in the SLF, Cg, and CC. Specifically, the SLF and CC exhibited decreased FA accompanied by increased MD, while the Cg primarily showed decreased FA. Further correlation analysis revealed that CC damage was associated with global cognitive decline, SLF damage was associated with executive function decline, and Cg damage was associated with memory function decline. These findings suggest that cognitive dysfunction after radiochemotherapy in patients with frontal lobe glioma is not merely attributable to focal damage to a single brain region, but may instead be related to disruption of the cognitive-related white matter connection network. In the present study, patients mainly exhibited a decline in global cognitive function after radiochemotherapy, accompanied by a trend toward impairment in executive and memory functions, which is generally consistent with the functional anatomical characteristics of the frontal lobe [ 18 , 19 ]. Meanwhile, the decline in memory function may not be solely attributed to local gray matter damage but may also result from reduced information integration efficiency between the frontal lobe and the limbic system [ 20 ]. Previous studies have often observed treatment-related injury at the level of whole-brain white matter or local brain regions; however, the present study further localized the abnormalities to specific white matter fiber tracts, suggesting that cognitive impairment may not merely reflect functional decline in localized brain regions, but rather represents a comprehensive manifestation of damage to key connection pathways within higher-order cognitive networks. From a network perspective, the changes in the SLF, Cg, and CC exhibit a relatively clear structure–function correspondence. The SLF is an important structural pathway of the frontoparietal control network, involved in higher-order cognitive activities such as executive control, attentional switching, and working memory [ 21 , 22 ]; its damage correlated with declines in visuospatial and executive function, suggesting that the decline in executive control ability after radiochemotherapy may be closely related to impaired frontoparietal connectivity. The Cg connects the frontal lobe, cingulate gyrus, and regions associated with the limbic system, playing a key role in memory retrieval, internal information integration, and cognitive control [ 23 , 24 ]; its abnormalities correlated with delayed recall decline, indicating that treatment-related memory impairment may be associated with disruption of frontal–limbic connections. As the major pathway for interhemispheric information integration [ 25 , 26 ], the CC correlated with changes in MoCA total score, suggesting that damage to this tract may have a broader impact extending beyond a single cognitive domain. Thus, the observed findings do not simply reflect scattered abnormalities in several fiber tracts, but rather point to a selective vulnerability of key connecting edges within the higher-order frontal cognitive network. It is noteworthy that in this study, white matter microstructural abnormalities predominantly emerged at 6 months after radiochemotherapy, whereas changes at 1 month postoperatively were relatively subtle, suggesting a certain degree of delayed onset and cumulative nature of cognitive impairment and white matter alterations [ 8 , 27 ]. In the early postoperative period, local tissue edema, surgical site repair, and neural functional compensation may coexist, obscuring the full manifestation of structural and functional changes. As the effects of radiochemotherapy accumulate progressively, pathological processes such as oligodendrocyte injury, demyelination, microvascular damage, and chronic neuroinflammation further develop [ 7 , 28 ], ultimately manifesting as more pronounced FA decrease and MD increase at the 6-month follow-up. This time-dependent evolution of cognitive dysfunction indicates a continuously progressive process, highlighting the need to adjust treatment strategies accordingly—including risk identification, radiotherapy optimization, and rehabilitation intervention—based on this temporal pattern. Furthermore, it is equally noteworthy that not all white matter fiber tracts exhibited abnormalities. In this study, the uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), and arcuate fasciculus (AF), which are associated with language function, as well as the corticospinal tract (CST) serving as a negative control, showed no significant abnormalities across the three time points. In contrast, damage was more prominent in the SLF, Cg, and CC, suggesting that white matter injury after radiochemotherapy does not occur homogenously throughout the brain, but rather preferentially involves the key pathways closely associated with higher-order cognitive functions of the frontal lobe [ 29 ]. In other words, white matter damage following radiochemotherapy may exhibit a pattern of preferential involvement of cognitive-related pathways. This study also found that the proportion of partial resection was higher in the cognitive decline group, suggesting that the extent of resection may be associated with cognitive outcomes. Compared with complete resection, patients with partial resection had a larger residual tumor burden, which may exert persistent mass effects, infiltrative impacts, and interference with white matter fiber tract integrity on the frontal local network, while also reducing postoperative neural functional compensation capacity, thereby increasing the risk of subsequent cognitive decline [ 7 , 30 , 31 ]. This finding suggests that maximizing the extent of safe resection while ensuring neurological safety may help improve long-term cognitive outcomes in patients. However, the relationship between the extent of resection and cognitive outcomes remains influenced by multiple factors, including tumor location, infiltration range, intraoperative assistance, and individual brain functional reserve, warranting the use of more surgical modalities to achieve maximal safe resection. Although the radiation dose was slightly higher in the cognitive decline group than in the stable group, the difference was not statistically significant, suggesting that the radiation dose alone was not the primary factor contributing to cognitive decline in this study. However, this finding does not negate the adverse effects of radiotherapy; rather, it suggests that cognitive impairment likely results from the combined effects of “indirect effects of treatment (such as microstructural damage to white matter fiber tracts) + residual tumor burden + disruption of network connections caused by surgery.” Among these, radiotherapy may serve as the core structural basis for the selective damage to cognitive-related white matter fiber tracts, such as the SLF, Cg, and CC, by inducing oligodendrocyte apoptosis, demyelination, and chronic neuroinflammation [ 29 , 32 ], ultimately leading to declines in executive and memory functions. However, further research is needed to confirm this. From the perspective of imaging metrics, the changes in cognitive function in this study were significantly correlated primarily with ΔFA, whereas ΔMD showed no significant correlation with changes in MoCA total score or scores in any cognitive domain. This suggests that FA may be more sensitive to treatment-related microstructural abnormalities in white matter. A decrease in FA typically reflects reduced fiber alignment and compromised structural integrity, allowing early detection of microstructural disorganization in white matter fiber tracts [ 33 ]; in contrast, although MD increased in some fiber tracts, its correspondence with cognitive function changes was relatively limited. Based on these findings, DTI, particularly the FA parameter, is closely associated with cognitive function changes in patients with frontal lobe glioma after radiochemotherapy and may serve as an objective imaging reference for assessing treatment-related cognitive impairment. The findings of this study have certain clinical implications. First, while ensuring tumor control, postoperative radiotherapy planning may consider enhancing the protection of cognitive-related white matter fiber tracts, particularly the SLF, Cg, and CC, to minimize high-dose irradiation damage to these critical connection pathways. Second, during follow-up, in addition to monitoring tumor control and conventional imaging changes, dynamic assessment using MoCA and DTI in patients at high risk for cognitive impairment may facilitate early identification of treatment-related cognitive injury. Third, early screening and intervention targeting executive and memory functions may help improve patients‘ long-term quality of life and social functional recovery. In addition, this study has several limitations. First, the sample size was relatively small, and the follow-up duration was only 6 months, which may not be sufficient to fully elucidate long-term cognitive outcomes and the dynamic evolution of white matter damage. Second, the independent effects of radiotherapy and chemotherapy were not further distinguished, and more detailed neuropsychological assessments and multimodal imaging validation are lacking. Future studies with larger sample sizes, longer follow-up periods, and dosimetric analysis are needed to further develop predictive models and intervention strategies for treatment-related cognitive impairment. Nevertheless, this study provides insights into the structural basis of cognitive dysfunction in patients with frontal lobe glioma after radiochemotherapy from the perspective of white matter fiber tract networks, offering imaging evidence to support the optimization of comprehensive treatment strategies, enhancement of cognitive protection, and improvement of patients’ quality of life. Abbreviations DTI Diffusion tensor imaging MoCA Montreal Cognitive Assessment FA Fractional anisotropy MD Mean diffusivity SLF Superior longitudinal fasciculus Cg Cingulum CC Corpus callosum UF Uncinate fasciculus IFOF Inferior fronto-occipital fasciculus AF Arcuate fasciculus CST Corticospinal tract IMRT Intensity-modulated radiotherapy TMZ Temozolomide. Declarations Ethics approval and consent to participate This retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of The First Affiliated Hospital of Jishou University (Approval No. XXZRY-LCKY-2025-16). The Ethics Committee waived the requirement for informed consent because: (1) the study posed minimal risk; (2) all data were analyzed anonymously from existing medical records; (3) no additional interventions were performed; and (4) obtaining consent was impracticable due to the retrospective design. All patient data were de-identified prior to analysis to ensure confidentiality. Consent for publication Not applicable. This manuscript does not contain any individual person’s data in any form (including individual details, images, or videos). Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to patient privacy and ethical restrictions, but are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This work was supported by the Major Research Project of the National Key Clinical Specialty of China (Grant No. 20230309), the Natural Science Foundation of Hunan Province, China (Grant No. 2024JJ7558), and the Scientific Research Project of Jishou University, China (Grant No. Jdzd24049). Authors’ contributions Jia Chen: Conceptualization, Methodology, Formal analysis, Writing - Original Draft. Xiaoping Li: Data curation, Investigation, Visualization. Zhi Tian: Data curation, Investigation. Chunhai Huang: Data curation, Validation. Yi Wan: Software, Validation. Zhao Wang: Conceptualization, Resources, Writing - Review & Editing, Supervision, Funding acquisition. All authors read and approved the final manuscript. Acknowledgements We would like to express our gratitude to the Jiaolong Deshui JLDS Anatomy Laboratory 6.0 for providing excellent anatomical equipment and facilities. We also thank the donor cadavers for providing high-quality cranial and fiber tract anatomical specimens. Additionally, we acknowledge Professor Fang-Cheng Yeh from Stanford University for providing the open-source DSI Studio software, which enabled individualized fiber tract tracking in this study. References Puglisi G, Howells H, Sciortino T, Leonetti A, Rossi M, Nibali MC, et al. Frontal pathways in cognitive control: direct evidence from intraoperative stimulation and diffusion tractography. Brain. 2019;142(9):2601–13. 10.1093/brain/awz178 . Johnson DR, Sawyer AM, Meyers CA, O’Neill BP, Wefel JS. Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma. Neuro-Oncol. 2012;14:808–16. https://doi.org/10.1093/neuonc/nos082 . Van Kessel E, Huenges Wajer IMC, Ruis C, Seute T, Fonville S, De Vos FYFL, et al. Cognitive impairments are independently associated with shorter survival in diffuse glioma patients. J Neurol. 2021;268:1434–42. https://doi.org/10.1007/s00415-020-10303-w . Jiang T, Mao Y, Ma W, Mao Q, You Y, Yang X, et al. CGCG clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett. 2016;375:263–73. https://doi.org/10.1016/j.canlet.2016.01.024 . Haldbo-Classen L, Amidi A, Lukacova S, Wu LM, Oettingen GV, Lassen-Ramshad Y, et al. Cognitive impairment following radiation to hippocampus and other brain structures in adults with primary brain tumours. Radiother Oncol. 2020;148:1–7. https://doi.org/10.1016/j.radonc.2020.03.023 . Aznar MC, Davey A, Wilson LJ, Osorio EV, Bulbeck H, Thomson A, et al. Cognitive outcomes after radiotherapy for medulloblastoma: a voxel-based analysis. Int J Radiat Oncol. 2026. https://doi.org/10.1016/j.ijrobp.2026.03.007 . S036030162600492X. Li X, Ding Z. Cognitive dysfunction induced by cranial radiotherapy: mechanisms and therapeutic methods. Brain Res Bull. 2024;218:111106. https://doi.org/10.1016/j.brainresbull.2024.111106 . Wang J, Oppong PKJ, Kitagawa M, Aoyama H, Onodera S, Terae S, et al. DTI Histogram and Texture Features as Early Predictors of Post-Radiotherapy Cognitive Decline. Appl Sci. 2025;15:6794. https://doi.org/10.3390/app15126794 . Kłos J, Dijkstra H, Van Der Weide HL, Potze JH, Sinnige PF, Ng Wei Siang K, et al. Relationship between DTI-MRI derived metrics and radiotherapy dose range in the contralateral cerebrum in lower grade glioma. Front Oncol. 2025;15:1406340. https://doi.org/10.3389/fonc.2025.1406340 . Yang Z-C, Yin C-D, Yeh F-C, Xue B-W, Song X-Y, Li G, et al. A preliminary study on corticospinal tract morphology in incidental and symptomatic insular low-grade glioma: implications for post-surgical motor outcomes. NeuroImage Clin. 2023;40:103521. https://doi.org/10.1016/j.nicl.2023.103521 . Kocher M, Jockwitz C, Lohmann P, Stoffels G, Filss C, Mottaghy FM, et al. Lesion-Function Analysis from Multimodal Imaging and Normative Brain Atlases for Prediction of Cognitive Deficits in Glioma Patients. Cancers. 2021;13:2373. https://doi.org/10.3390/cancers13102373 . Wende T, Güresir E, Wach J, Vychopen M, Hoffmann A, Prasse G, et al. Radiomic white matter parameters of functional integrity of the corticospinal tract in high-grade glioma. Sci Rep. 2024;14:12891. https://doi.org/10.1038/s41598-024-63813-2 . Young JS, Morshed RA, Hervey-Jumper SL, Berger MS. The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions. Neuro-Oncol. 2023;25:2117–33. https://doi.org/10.1093/neuonc/noad133 . Jiang T, Nam D-H, Ram Z, Poo W, Wang J, Boldbaatar D, et al. Updated clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett. 2026;640:218185. https://doi.org/10.1016/j.canlet.2025.218185 . Yeh F-C, Verstynen TD, Wang Y, Fernández-Miranda JC, Tseng W-YI. Deterministic Diffusion Fiber Tracking Improved by Quantitative Anisotropy. Zhan W, editor. PLoS ONE. 2013;8:e80713. https://doi.org/10.1371/journal.pone.0080713 Mori S, Oishi K, Jiang H, Jiang L, Li X, Akhter K, et al. Stereotaxic white matter atlas based on diffusion tensor imaging in an ICBM template. NeuroImage. 2008;40:570–82. https://doi.org/10.1016/j.neuroimage.2007.12.035 . Van Kessel E, Baumfalk AE, Van Zandvoort MJE, Robe PA, Snijders TJ. Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment. J Neurooncol. 2017;134:9–18. https://doi.org/10.1007/s11060-017-2503-z . Le Bouc R, Garcin B, Urbanski M, Volle E, Dubois B, Levy R. Anatomy and Disorders of Frontal Lobe Functions: Fundamental Functions. Encycl Behav Neurosci 2nd Ed [Internet]. Elsevier; 2022 [cited 2026 Mar 22]. pp. 266–79. https://doi.org/10.1016/B978-0-12-819641-0.00065-7 Khasraw M, Lassman AB. Late neurocognitive decline after radiotherapy for low-grade glioma. Nat Rev Neurol. 2009;5:646–7. https://doi.org/10.1038/nrneurol.2009.194 . La Corte V, Sperduti M, Malherbe C, Vialatte F, Lion S, Gallarda T, et al. Cognitive Decline and Reorganization of Functional Connectivity in Healthy Aging: The Pivotal Role of the Salience Network in the Prediction of Age and Cognitive Performances. Front Aging Neurosci [Internet]. 2016. https://doi.org/10.3389/fnagi.2016.00204 . [cited 2026 Mar 22];8. Nakajima R, Kinoshita M, Shinohara H, Nakada M. The superior longitudinal fascicle: reconsidering the fronto-parietal neural network based on anatomy and function. Brain Imaging Behav. 2020;14:2817–30. https://doi.org/10.1007/s11682-019-00187-4 . Zheng Y, Bo B, Wang D, Liu Y, Shi L, Gilbert SJ, et al. Microstructural organization of superior longitudinal fasciculus and cingulum bundle support metacognition driven cognitive offloading. Sci Rep. 2025;15:33247. https://doi.org/10.1038/s41598-025-18631-5 . Rolls ET. The cingulate cortex and limbic systems for emotion, action, and memory. Brain Struct Funct. 2019;224:3001–18. https://doi.org/10.1007/s00429-019-01945-2 . Kollenburg L, Arnts H, Green A, Strauss I, Vinke S, Kurt E. The cingulum: anatomy, connectivity and what goes beyond. Brain Commun. 2024;7:fcaf048. https://doi.org/10.1093/braincomms/fcaf048 . Bhatt RR, Gadewar SP, Shetty A, Ba Gari I, Haddad E, Javid S et al. The Genetic Architecture of the Human Corpus Callosum and its Subregions [Internet]. Neuroscience; 2024 [cited 2026 Mar 22]. https://doi.org/10.1101/2024.07.22.603147 Mooshagian E. Anatomy of the Corpus Callosum Reveals Its Function. J Neurosci. 2008;28:1535–6. https://doi.org/10.1523/JNEUROSCI.5426-07.2008 . Dropcho EJ. Neurotoxicity of Radiation Therapy. Neurol Clin. 2010;28:217–34. https://doi.org/10.1016/j.ncl.2009.09.008 . Witzmann K, Raschke F, Troost EGC. MR Image Changes of Normal-Appearing Brain Tissue after Radiotherapy. Cancers. 2021;13:1573. https://doi.org/10.3390/cancers13071573 . Shamsesfandabadi P, Patel A, Liang Y, Shepard M, Wegner R. Radiation-Induced Cognitive Decline: Challenges and Solutions. Cancer Manag Res 2024;Volume 16:1043–52. https://doi.org/10.2147/CMAR.S441360 Hall WA, Pugh SL, Wefel JS, Armstrong TS, Gilbert MR, Brachman DG, et al. Influence of Residual Disease Following Surgical Resection in Newly Diagnosed Glioblastoma on Clinical, Neurocognitive, and Patient Reported Outcomes. Neurosurgery. 2019;84:66–76. https://doi.org/10.1093/neuros/nyy003 . Wang Q, Xiao F, Qi F, Song X, Yu Y. Risk Factors for Cognitive Impairment in High-Grade Glioma Patients Treated with Postoperative Radiochemotherapy. Cancer Res Treat. 2020;52:586–93. https://doi.org/10.4143/crt.2019.242 . Burns TC, Awad AJ, Li MD, Grant GA. Radiation-induced brain injury: low-hanging fruit for neuroregeneration. Neurosurg Focus. 2016;40:E3. https://doi.org/10.3171/2016.2.FOCUS161 . Lucic M, Djan I, Sveljo O, Lucic S, Ivanov O, Bjelan M, et al. Multiparametric structural imaging biomarkers of early white matter microstructural changes during and after glioblastoma chemoradiotherapy: Diffusion tensor imaging and diffusion kurtosis imaging. Vojnosanit Pregl. 2026;83:21–30. https://doi.org/10.2298/VSP250525083L . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 28 Apr, 2026 Reviewers invited by journal 28 Apr, 2026 Editor assigned by journal 26 Apr, 2026 Editor invited by journal 03 Apr, 2026 Submission checks completed at journal 02 Apr, 2026 First submitted to journal 02 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9225199","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634832205,"identity":"b582c37d-e8cc-4db8-9b86-a2453b2ca191","order_by":0,"name":"Jia Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Jishou University","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Chen","suffix":""},{"id":634832209,"identity":"9007cbc4-ae94-482d-a753-be75398fb293","order_by":1,"name":"Xiaoping Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Jishou University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoping","middleName":"","lastName":"Li","suffix":""},{"id":634832214,"identity":"121254bf-19c1-461d-a129-62dca469ac0f","order_by":2,"name":"Zhi Tian","email":"","orcid":"","institution":"The First Affiliated Hospital of Jishou University","correspondingAuthor":false,"prefix":"","firstName":"Zhi","middleName":"","lastName":"Tian","suffix":""},{"id":634832215,"identity":"3c22e50a-ab0b-4bbe-901d-8a00d225c0dc","order_by":3,"name":"Chunhai Huang","email":"","orcid":"","institution":"The First Affiliated Hospital of Jishou University","correspondingAuthor":false,"prefix":"","firstName":"Chunhai","middleName":"","lastName":"Huang","suffix":""},{"id":634832216,"identity":"3d8a7489-e03b-4e77-a66a-6efcf5fe896a","order_by":4,"name":"Yi Wan","email":"","orcid":"","institution":"The First Affiliated Hospital of Jishou University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Wan","suffix":""},{"id":634832217,"identity":"ddd3b6ad-12b5-490c-ad13-8b98e673c72a","order_by":5,"name":"Zhao Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYLACxgYGBjb25oMPPlRIyMkTrYWP51iy4YwzFsaGDcRqkZPIMZPmbatIZDhAQLXB8bOHX/7cYSfHJpFjIME7TyKBsYH54aMb+LScyUuzkDyTbMzG86zAQHKbRB47A5uxcQ4eLWYHcswMDNuYE9vYkzckGG6TKGZs4GGTxqvl/Bszg8S2+sQ2hgSDA4lzJBIbDhDSciPH+MHBtsOJbRwphg0HG4jQYn/jjRljY9txoF+OJTM2HJMwNmwm4BfJ/hzjjz/bquXk25uP//5TUycnz9788DE+LUDAJoHKZ8avHKzkA2E1o2AUjIJRMKIBAB6wTxUSYZjsAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Jishou University","correspondingAuthor":true,"prefix":"","firstName":"Zhao","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-03-25 15:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9225199/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9225199/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108941725,"identity":"b136ce6a-a552-4a6c-b7c8-216c9e912bb5","added_by":"auto","created_at":"2026-05-11 05:37:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1465481,"visible":true,"origin":"","legend":"\u003cp\u003eCognitive function changes before and after radiochemotherapy in patients with frontal lobe glioma.\u003c/p\u003e\n\u003cp\u003e(A) MoCA domain scores (bar chart). Scores of seven cognitive domains at T0 (blue), T1 (orange), and T2 (green). Visuospatial/executive function and delayed recall showed declining trends at T2 (†). Error bars: SD.\u003c/p\u003e\n\u003cp\u003e(B) MoCA total scores (line chart). Total MoCA score (0-30) decreased significantly at T2 vs T1 and T0 (*\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0167, Bonferroni correction).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9225199/v1/4cf86c97c3375c7c5a5f8674.png"},{"id":108977586,"identity":"67725a3c-d210-4c74-b135-99f791a784fe","added_by":"auto","created_at":"2026-05-11 11:32:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1849024,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in DTI parameters before and after radiochemotherapy.\u003c/p\u003e\n\u003cp\u003e(A) Fractional anisotropy (FA). FA values decreased significantly at T2 in the SLF, Cg, and CC (*\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0167, Bonferroni correction), indicating reduced white matter integrity.\u003c/p\u003e\n\u003cp\u003e(B) Mean diffusivity (MD). MD values increased significantly at T2 in the SLF and CC (*\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0167), suggesting demyelination or microstructural damage.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9225199/v1/e7e9b9c4212a1ae7340afc10.png"},{"id":108978021,"identity":"4356d735-6edf-497f-94c0-c5d5d1e6f651","added_by":"auto","created_at":"2026-05-11 11:33:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":286695,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelations between DTI parameter changes in fiber tracts and cognitive function changes\u003c/p\u003e\n\u003cp\u003eA: Correlation between FA change in the corpus callosum and change in cognitive function, r=0.593, \u003cem\u003eP\u003c/em\u003e=0.003;\u003c/p\u003e\n\u003cp\u003eB: Correlation between FA change in the superior longitudinal fasciculus and change in executive function, r=0.364, \u003cem\u003eP\u003c/em\u003e=0.007;\u003c/p\u003e\n\u003cp\u003eC: Correlation between FA change in the cingulum and change in memory function, r=0.349, \u003cem\u003eP\u003c/em\u003e=0.012.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9225199/v1/bb0c7adcc6a68348511fa45f.png"},{"id":108941727,"identity":"cb11dfcc-d2eb-411e-a4ce-8b3983162c0e","added_by":"auto","created_at":"2026-05-11 05:37:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1803573,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagrams of frontal lobe anatomy and three-dimensional reconstruction of white matter fiber tracts\u003c/p\u003e\n\u003cp\u003eA: Schematic diagram of gross anatomy of the normal frontal lobe;\u003cbr\u003e\nB: Three-dimensional reconstruction of white matter fiber tracts associated with the normal frontal lobe;\u003cbr\u003e\nC: Three-dimensional reconstruction of white matter fiber tracts associated with the frontal lobe in a patient with frontal lobe glioma before radiotherapy;\u003cbr\u003e\nD: Three-dimensional reconstruction of white matter fiber tracts associated with the frontal lobe in the same patient after radiotherapy.\u003cbr\u003e\nMorphological differences in the frontal lobe-associated white matter fiber tracts can be observed before and after radiotherapy.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9225199/v1/45d1485e30f6043f461b7aca.png"},{"id":108979874,"identity":"696812eb-5e4d-4bea-81b5-66939a743d98","added_by":"auto","created_at":"2026-05-11 12:02:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5879399,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9225199/v1/a410fb11-2875-46f9-b2d1-5cc7a8d18d38.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diffusion Tensor Imaging Study of Cognitive Dysfunction After Radiochemotherapy for Frontal Lobe Glioma","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003ePatients with frontal lobe glioma often present with varying degrees of cognitive impairment [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. With the continuous improvement in comprehensive treatment modalities combining surgery with radiochemotherapy, patient survival has been prolonged; however, the occurrence of cognitive dysfunction has become a critical factor affecting patients\u0026lsquo; quality of life [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Diffusion tensor imaging (DTI) can sensitively detect microstructural changes in cerebral white matter fiber tracts [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], yet existing studies have predominantly focused on the corticospinal tract related to motor function [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], with a lack of longitudinal dynamic assessments targeting cognitive-related white matter fiber tracts. Therefore, this study employs DTI fiber tractography to longitudinally monitor microstructural changes in cognitive-related white matter fiber tracts in patients with frontal lobe glioma before and after radiochemotherapy, and to explore their correlation with cognitive impairment, aiming to elucidate the structural basis of post-radiochemotherapy cognitive injury at the level of white matter connection networks, and to provide imaging evidence for early identification of high-risk populations and the development of individualized protective strategies in clinical practice.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Participants\u003c/h2\u003e \u003cp\u003ePatients with frontal lobe glioma treated at The First Affiliated Hospital of Jishou University (Xiangxi Tujia and Miao Autonomous Prefecture People\u0026rsquo;s Hospital) from June 2023 to June 2025 were retrospectively enrolled. This study was approved by the Ethics Committee of The First Affiliated Hospital of Jishou University (Approval No. XXZRY-LCKY-2025-16). Due to the retrospective design and the use of anonymized data with minimal risk to patients, the Ethics Committee waived the requirement for written informed consent.\u003c/p\u003e \u003cp\u003eInclusion criteria: (1) Age 18\u0026ndash;70 years; (2) Pathologically confirmed frontal lobe glioma (WHO grade 2\u0026ndash;4) after surgery; (3) First surgical treatment followed by concurrent radiochemotherapy; (4) Completed MRI examination and cognitive assessment at preoperative, 1 month postoperative, and 6 months post-radiochemotherapy; (5) Right-handed; (6) Education duration\u0026thinsp;\u0026ge;\u0026thinsp;6 years and able to cooperate with cognitive assessment.\u003c/p\u003e \u003cp\u003eExclusion criteria: (1) Bilateral frontal lobe or multiple lesions; (2) Previous history of cranial radiotherapy; (3) Recurrence or progression of intracranial tumor; (4) Severe mental illness, uncontrolled epilepsy, Alzheimer's disease, or other conditions affecting cognitive function; (5) Contraindications to MRI (e.g., cardiac pacemaker, metallic implants, severe claustrophobia); (6) Pregnant or lactating women; (7) Occurrence of traumatic brain injury, cerebrovascular accident, or other events that may affect the accuracy of cognitive assessment during follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Treatment Protocol\u003c/h2\u003e \u003cp\u003eAll patients underwent microscopic resection of frontal lobe glioma. MRI was performed within 72 hours after surgery to evaluate the extent of resection, which was classified as complete resection (no significant residual tumor) or partial resection (residual tumor present). Postoperative adjuvant treatment was formulated according to the pathological grade and molecular pathology findings, following the Guidelines for the Diagnosis and Treatment of Glioma [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Radiotherapy was delivered using intensity-modulated radiotherapy (IMRT). The total radiation dose ranged from 45 to 60 Gy, with a fractionated dose of 1.8\u0026ndash;2.0 Gy per fraction, 5 fractions per week, prescribed according to tumor grade and molecular pathology. Concurrent chemotherapy was administered using temozolomide (TMZ) at 75 mg/(m\u0026sup2;\u0026middot;d). After radiotherapy, adjuvant chemotherapy was given with TMZ at a dose of 150\u0026ndash;200 mg/(m\u0026sup2;\u0026middot;d) for 5 consecutive days, repeated every 28 days, for a total of 6 cycles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Cognitive Assessment\u003c/h2\u003e \u003cp\u003eCognitive function was assessed using the Montreal Cognitive Assessment (MoCA) in all patients. Assessments were performed at three time points: preoperative (T0), 1 month postoperative (T1), and 6 months post-radiochemotherapy (T2). The MoCA scale encompasses seven cognitive domains: visuospatial/executive function, naming, attention, language, abstraction, delayed recall, and orientation, with a total score of 30 points. For patients with education duration\u0026thinsp;\u0026le;\u0026thinsp;12 years, one point was added to the total score (original maximum 30 points, maximum after adjustment 31 points). All assessments were conducted by uniformly trained physicians in a quiet environment on a one-to-one basis, and whenever possible, the same physician performed the assessments at each time point to minimize evaluation bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 MRI Data Acquisition\u003c/h2\u003e \u003cp\u003eMRI was performed using a Siemens 3.0T scanner (MAGNETOM Verio, Siemens Healthcare, Germany) with a 32-channel head coil. The scanning sequences and parameters were as follows:\u003c/p\u003e \u003cp\u003e(1) Conventional MRI: T1-weighted imaging (T1WI: TR 250 ms, TE 2.5 ms), T2-weighted imaging (T2WI: TR 4000 ms, TE 95 ms), and fluid-attenuated inversion recovery (FLAIR: TR 8000 ms, TE 95 ms, TI 2200 ms). Slice thickness was 5 mm with a 1 mm interslice gap, and the matrix was 256 \u0026times; 256.\u003c/p\u003e \u003cp\u003e(2) 3D-T1 structural imaging: Magnetization-prepared rapid gradient echo (MPRAGE) sequence with TR 1900 ms, TE 2.5 ms, TI 900 ms, flip angle 9\u0026deg;, slice thickness 1.0 mm with no gap, matrix 256 \u0026times; 256, and voxel size 1.0 mm \u0026times; 1.0 mm \u0026times; 1.0 mm.\u003c/p\u003e \u003cp\u003e(3) Diffusion tensor imaging (DTI): Single-shot spin echo echo-planar imaging (SE-EPI) sequence with TR 8000 ms, TE 95 ms, flip angle 90\u0026deg;, slice thickness 2.0 mm with no gap, matrix 128 \u0026times; 128, and voxel size 2.0 mm \u0026times; 2.0 mm \u0026times; 2.0 mm. Diffusion-sensitizing gradients were applied in 30 directions with b-values of 0 and 1000 s/mm\u0026sup2;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 DTI Data Processing and Analysis\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.5.1 Data Preprocessing\u003c/h2\u003e \u003cp\u003eDTI data were processed and analyzed using DSI Studio (Version 2025, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dsi-studio.labsolver.org\u003c/span\u003e\u003cspan address=\"http://dsi-studio.labsolver.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Raw DICOM data were first converted to SRC format, followed by motion correction and eddy current correction. Subsequently, the generalized q-sampling imaging (GQI) algorithm was employed for reconstruction to enable whole-brain fiber tractography. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted as the primary analytical metrics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.5.2 Fiber Tractography\u003c/h2\u003e \u003cp\u003eDeterministic fiber tracking based on quantitative anisotropy (QA) was performed for whole-brain fiber tract reconstruction. The tracking parameters were set as follows: QA threshold 0.1, angle threshold 45\u0026deg;, step length 1.0 mm, and fiber length threshold 20\u0026ndash;300 mm. Based on the ICBM-DTI-81 white matter atlas[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], the following fiber tracts of interest were extracted using an automated fiber tract identification method: (1) superior longitudinal fasciculus (SLF); (2) cingulum (Cg); (3) corpus callosum (CC); (4) uncinate fasciculus (UF); (5) inferior fronto-occipital fasciculus (IFOF); (6) arcuate fasciculus (AF); and (7) corticospinal tract (CST), which served as a negative control. Each extracted fiber tract was visually inspected to ensure accurate anatomical localization.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.5.3 Fiber Tract Parameter Extraction and Calculation\u003c/h2\u003e \u003cp\u003eAfter reconstructing the target fiber tracts using fiber tractography, the mean fractional anisotropy (FA) and mean diffusivity (MD) of each fiber tract were extracted at the whole-tract level. The changes in DTI parameters for each fiber tract were calculated as follows: ΔFA\u0026thinsp;=\u0026thinsp;T2 FA\u0026thinsp;\u0026minus;\u0026thinsp;T1 FA, ΔMD\u0026thinsp;=\u0026thinsp;T2 MD\u0026thinsp;\u0026minus;\u0026thinsp;T1 MD.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS 26.0 software (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s), and categorical variables were presented as counts (%). Repeated measures analysis of variance was used to compare cognitive scores and DTI parameters across the three time points (T0, T1, T2), with pairwise comparisons adjusted using the Bonferroni correction. Pearson correlation analysis or Spearman rank correlation analysis was employed to evaluate the associations between changes in DTI parameters (ΔFA, ΔMD) of key fiber tracts and changes in MoCA total scores as well as scores in each cognitive domain. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Ethics Statement\u003c/h2\u003e \u003cp\u003e This retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of The First Affiliated Hospital of Jishou University (Approval No. XXZRY-LCKY-2025-16). The Ethics Committee waived the requirement for informed consent because: (1) the study posed minimal risk; (2) all data were analyzed anonymously from existing medical records; (3) no additional interventions were performed; and (4) obtaining consent was impracticable due to the retrospective design. All patient data were de-identified prior to analysis to ensure confidentiality.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic and Clinical Characteristics\u003c/h2\u003e \u003cp\u003eA total of 40 patients with frontal lobe glioma were enrolled in this study, including 21 males (52.5%) and 19 females (47.5%). The mean age was 50.28\u0026thinsp;\u0026plusmn;\u0026thinsp;13.52 years (range, 21\u0026ndash;70 years). Regarding educational level, 18 patients (45.0%) had primary school education, 15 (37.5%) had secondary school education, and 7 (17.5%) had college education or above. Tumors were located in the left frontal lobe in 22 cases (55.0%) and in the right frontal lobe in 18 cases (45.0%). According to WHO grade, there were 14 cases (35.0%) of grade II, 12 cases (30.0%) of grade III, and 14 cases (35.0%) of grade IV. Complete resection was achieved in 26 patients (65.0%), while partial resection was performed in 14 patients (35.0%). All patients received intensity-modulated radiotherapy (IMRT), with a mean radiation dose of 57.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86 Gy. The mean radiation dose was 57.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71 Gy in the cognitive decline group and 56.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93 Gy in the cognitive stable group. The preoperative MoCA score was 25.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18, and the 1-month postoperative MoCA score was 25.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43. The mean preoperative tumor volume was 38.52\u0026thinsp;\u0026plusmn;\u0026thinsp;16.73 cm\u0026sup3;.\u003c/p\u003e \u003cp\u003eBased on the change in MoCA score at 6 months post-radiochemotherapy compared with that at 1 month postoperatively, patients were divided into a cognitive decline group (decline\u0026thinsp;\u0026ge;\u0026thinsp;2 points, n\u0026thinsp;=\u0026thinsp;16) and a cognitive stable group (decline\u0026thinsp;\u0026lt;\u0026thinsp;2 points or score improvement, n\u0026thinsp;=\u0026thinsp;24). No significant differences were observed between the two groups in terms of age, sex, educational level, tumor laterality, WHO grade, radiotherapy modality, radiation dose, preoperative or 1-month postoperative MoCA scores, or preoperative tumor volume (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparability between the groups. A statistically significant difference was found in the extent of resection between the two groups (χ\u0026sup2; = 5.253, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022): the proportion of patients with partial resection was 56.3% (9/16) in the cognitive decline group, which was higher than that in the cognitive stable group (20.8%, 5/24), suggesting that patients with partial resection were more likely to experience cognitive decline after radiochemotherapy(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics of the study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall(n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCognitive decline group (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCognitive stable group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year, xˉ\u0026plusmn;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.28\u0026thinsp;\u0026plusmn;\u0026thinsp;13.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.63\u0026thinsp;\u0026plusmn;\u0026thinsp;12.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.38\u0026thinsp;\u0026plusmn;\u0026thinsp;14.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex〔n(%)〕\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003cp\u003e〔n(%)〕\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor laterality〔n(%)〕\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;0.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHO grade\u003c/p\u003e \u003cp\u003e〔n(%)〕\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;1.956\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtent of resection\u003c/p\u003e \u003cp\u003e〔n(%)〕\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;5.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiation dose(Gy, xˉ\u0026plusmn;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative MoCA score(xˉ\u0026plusmn;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-month postoperative MoCA score(xˉ\u0026plusmn;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative tumor volume(cm\u0026sup3;, xˉ\u0026plusmn;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.52\u0026thinsp;\u0026plusmn;\u0026thinsp;16.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.85\u0026thinsp;\u0026plusmn;\u0026thinsp;16.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.45\u0026thinsp;\u0026plusmn;\u0026thinsp;15.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of cognitive function scores before and after radiochemotherapy((x̄ \u0026plusmn; s, points)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative(T0)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1-month postoperative(T1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6-month post-radiochemotherapy(T2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePairwise comparisons \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e23.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eT2\u0026thinsp;\u0026lt;\u0026thinsp;T1\u003csup\u003e\u0026lowast;\u003c/sup\u003e,\u003c/p\u003e \u003cp\u003eT2\u0026thinsp;\u0026lt;\u0026thinsp;T0\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisuospatial/executive function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNaming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbstraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed recall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003ea Pairwise comparisons were performed using the Bonferroni correction with a significance level set at α\u0026prime;=0.05/3\u0026thinsp;=\u0026thinsp;0.0167.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u0026lowast;\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0167 compared with T1; # \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0167 compared with T0.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eBold values indicate statistical significance in the overall repeated measures ANOVA (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of Cognitive Function Before and After Radiochemotherapy\u003c/h2\u003e \u003cp\u003eRepeated measures ANOVA revealed a statistically significant difference in MoCA total scores across the three time points (F\u0026thinsp;=\u0026thinsp;4.892, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eB\u003cb\u003e)\u003c/b\u003e. After Bonferroni correction, the MoCA total score at T2 was significantly lower than those at T1 and T0, indicating a significant decline in overall cognitive function at 6 months post-radiochemotherapy compared with both preoperative and 1-month postoperative levels.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAmong the cognitive domains, visuospatial/executive function (F\u0026thinsp;=\u0026thinsp;3.845, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025) and delayed recall (F\u0026thinsp;=\u0026thinsp;3.456, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036) showed statistically significant overall differences across time points; however, after Bonferroni correction, pairwise comparisons did not reach statistical significance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.0167), only suggesting a declining trend. No significant differences were observed across the three time points for language (F\u0026thinsp;=\u0026thinsp;1.892, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.156), attention (F\u0026thinsp;=\u0026thinsp;1.234, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.296), naming (F\u0026thinsp;=\u0026thinsp;0.367, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.694), abstraction (F\u0026thinsp;=\u0026thinsp;0.134, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.875), or orientation (F\u0026thinsp;=\u0026thinsp;0.223, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.801) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eA\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOverall, patients with frontal lobe glioma exhibited a decline in global cognitive function at 6 months after radiochemotherapy, with executive function and memory function showing more pronounced trends of impairment.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e(A) MoCA domain scores (bar chart). Scores of seven cognitive domains at T0 (blue), T1 (orange), and T2 (green). Visuospatial/executive function and delayed recall showed declining trends at T2 (\u0026dagger;). Error bars: SD.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e(B) MoCA total scores (line chart). Total MoCA score (0\u0026ndash;30) decreased significantly at T2 vs T1 and T0 (*\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0167, Bonferroni correction).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparison of DTI Parameters in Key Fiber Tracts Before and After Radiochemotherapy\u003c/h2\u003e \u003cp\u003eRepeated measures ANOVA revealed heterogeneity in the changes of DTI parameters across different fiber tracts. The specific results are as follows.\u003c/p\u003e \u003cp\u003eSuperior longitudinal fasciculus (SLF): FA values showed statistically significant differences across time points (F\u0026thinsp;=\u0026thinsp;5.234, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). After Bonferroni correction, FA values at T2 (0.423\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045) were lower than those at T1 (0.448\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041) and T0 (0.452\u0026thinsp;\u0026plusmn;\u0026thinsp;0.038). MD values also showed statistically significant differences across time points (F\u0026thinsp;=\u0026thinsp;4.567, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), with MD values at T2 [(0.768\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048 )\u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s ]being higher than those at T1 [(0.742\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045) \u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s].\u003c/p\u003e \u003cp\u003eCingulum (Cg): FA values showed statistically significant differences across time points (F\u0026thinsp;=\u0026thinsp;4.892, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), with FA values at T2 (0.438\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047) being lower than those at T1 (0.465\u0026thinsp;\u0026plusmn;\u0026thinsp;0.044). MD values also showed statistically significant differences across time points (F\u0026thinsp;=\u0026thinsp;4.234, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018); however, after Bonferroni correction, pairwise comparisons did not reach statistical significance, only suggesting an increasing trend.\u003c/p\u003e \u003cp\u003eCorpus callosum (CC): FA values showed statistically significant differences across time points (F\u0026thinsp;=\u0026thinsp;5.156, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008), with FA values at T2 (0.478\u0026thinsp;\u0026plusmn;\u0026thinsp;0.053) being lower than those at T1 (0.508\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050) and T0 (0.512\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048). MD values also showed statistically significant differences across time points (F\u0026thinsp;=\u0026thinsp;4.892, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), with MD values at T2[ (0.728\u0026thinsp;\u0026plusmn;\u0026thinsp;0.044 )\u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s] being higher than those at T1 [(0.702\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041) \u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s] (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), and arcuate fasciculus (AF): No statistically significant differences were observed in either FA or MD values across time points (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating no clear microstructural changes within 6 months after radiochemotherapy.\u003c/p\u003e \u003cp\u003eCorticospinal tract (CST), serving as a negative control, showed no statistically significant differences in either FA or MD values across time points (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), consistent with expectations.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cp\u003e(A) Fractional anisotropy (FA). FA values decreased significantly at T2 in the SLF, Cg, and CC (*\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0167, Bonferroni correction), indicating reduced white matter integrity.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cp\u003e(B) Mean diffusivity (MD). MD values increased significantly at T2 in the SLF and CC (*\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0167), suggesting demyelination or microstructural damage.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Correlation Between DTI Parameter Changes in Fiber Tracts and Cognitive Function Changes\u003c/h2\u003e \u003cp\u003eThe change in FA (ΔFA) of the corpus callosum (CC) was significantly positively correlated with the change in MoCA total score (ΔMoCA) (r\u0026thinsp;=\u0026thinsp;0.593, P\u0026thinsp;=\u0026thinsp;0.003), indicating that a greater decrease in CC FA was associated with a more pronounced decline in global cognitive function.\u003c/p\u003e \u003cp\u003eThe change in FA of the superior longitudinal fasciculus (SLF) was significantly positively correlated with the change in executive function (change in visuospatial/executive function score) (r\u0026thinsp;=\u0026thinsp;0.364, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), suggesting that the degree of SLF damage was closely associated with the magnitude of executive function decline.\u003c/p\u003e \u003cp\u003eThe change in FA of the cingulum (Cg) was significantly positively correlated with the change in memory function (change in delayed recall score) (r\u0026thinsp;=\u0026thinsp;0.349, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), indicating a specific association between microstructural damage of the cingulum and memory function decline. No significant correlations were found between ΔMD of any fiber tract and changes in MoCA total score or cognitive domain scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, no significant correlations were observed between DTI parameter changes of the uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), or arcuate fasciculus (AF) and changes in any cognitive domain (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), consistent with the absence of significant DTI parameter changes for these tracts. The corticospinal tract (CST), serving as a negative control, showed no correlations between its DTI parameter changes and any cognitive domain (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as expected.\u003c/p\u003e \u003cp\u003eThese findings suggest that cognitive dysfunction after radiochemotherapy exhibits fiber tract specificity: CC damage is primarily associated with global cognitive decline, SLF damage with executive function decline, and Cg damage with memory function decline.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA: Correlation between FA change in the corpus callosum and change in cognitive function, r\u0026thinsp;=\u0026thinsp;0.593, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003;\u003c/p\u003e \u003cp\u003eB: Correlation between FA change in the superior longitudinal fasciculus and change in executive function, r\u0026thinsp;=\u0026thinsp;0.364, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007;\u003c/p\u003e \u003cp\u003eC: Correlation between FA change in the cingulum and change in memory function, r\u0026thinsp;=\u0026thinsp;0.349, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Visualization of White Matter Fiber Tract Reconstruction\u003c/h2\u003e \u003cp\u003eTo provide visual representation of the white matter fiber tract changes before and after radiochemotherapy, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrates three-dimensional reconstructions of frontal lobe-associated white matter fiber tracts. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003eA shows a schematic diagram of normal frontal lobe gross anatomy. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003eB presents three-dimensional reconstruction of normal frontal lobe white matter fiber tracts, demonstrating the typical morphology of key fiber bundles including the superior longitudinal fasciculus (SLF), cingulum (Cg), and corpus callosum (CC). Figures\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003eC and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003eD compare three-dimensional reconstructions of frontal lobe white matter fiber tracts in a representative patient before and after radiotherapy, respectively. Morphological changes, including fiber tract thinning and reduced fiber density, can be observed following radiotherapy, consistent with the microstructural alterations reflected by decreased FA values in the SLF, Cg, and CC reported in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of DTI parameters in key fiber tracts before and after radiochemotherapy (xˉ\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFiber tract\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreoperative \u003c/p\u003e \u003cp\u003e(T0)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1-month postoperative\u003c/p\u003e \u003cp\u003e (T1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6-month post-radiochemotherapy\u003c/p\u003e \u003cp\u003e (T2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePairwise\u003c/p\u003e \u003cp\u003eComparisons \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperior longitudinal fasciculus (SLF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.452\u0026thinsp;\u0026plusmn;\u0026thinsp;0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.448\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.423\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT2\u0026thinsp;\u0026lt;\u0026thinsp;T1\u0026lowast;,\u003c/p\u003e \u003cp\u003eT2\u0026thinsp;\u0026lt;\u0026thinsp;T0#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.736\u0026thinsp;\u0026plusmn;\u0026thinsp;0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.742\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.768\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT2\u0026thinsp;\u0026gt;\u0026thinsp;T1\u0026lowast;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCingulum (Cg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.468\u0026thinsp;\u0026plusmn;\u0026thinsp;0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.465\u0026thinsp;\u0026plusmn;\u0026thinsp;0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.438\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT2\u0026thinsp;\u0026lt;\u0026thinsp;T1\u0026lowast;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.724\u0026thinsp;\u0026plusmn;\u0026thinsp;0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.728\u0026thinsp;\u0026plusmn;\u0026thinsp;0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.756\u0026thinsp;\u0026plusmn;\u0026thinsp;0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorpus callosum (CC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.512\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.508\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.478\u0026thinsp;\u0026plusmn;\u0026thinsp;0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT2\u0026thinsp;\u0026lt;\u0026thinsp;T1\u0026lowast;,\u003c/p\u003e \u003cp\u003eT2\u0026thinsp;\u0026lt;\u0026thinsp;T0#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.698\u0026thinsp;\u0026plusmn;\u0026thinsp;0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.702\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.728\u0026thinsp;\u0026plusmn;\u0026thinsp;0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT2\u0026thinsp;\u0026gt;\u0026thinsp;T1\u0026lowast;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncinate fasciculus (UF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.412\u0026thinsp;\u0026plusmn;\u0026thinsp;0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.410\u0026thinsp;\u0026plusmn;\u0026thinsp;0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.398\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.768\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.772\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.784\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInferior fronto-occipital fasciculus (IFOF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.435\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.432\u0026thinsp;\u0026plusmn;\u0026thinsp;0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.422\u0026thinsp;\u0026plusmn;\u0026thinsp;0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.752\u0026thinsp;\u0026plusmn;\u0026thinsp;0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.756\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.768\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArcuate fasciculus (AF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.442\u0026thinsp;\u0026plusmn;\u0026thinsp;0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.440\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.428\u0026thinsp;\u0026plusmn;\u0026thinsp;0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.742\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.745\u0026thinsp;\u0026plusmn;\u0026thinsp;0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.758\u0026thinsp;\u0026plusmn;\u0026thinsp;0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorticospinal tract (CST)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.528\u0026thinsp;\u0026plusmn;\u0026thinsp;0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.526\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.524\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.682\u0026thinsp;\u0026plusmn;\u0026thinsp;0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.684\u0026thinsp;\u0026plusmn;\u0026thinsp;0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.686\u0026thinsp;\u0026plusmn;\u0026thinsp;0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003ea Pairwise comparisons were performed using the Bonferroni correction with a significance level set at α\u0026prime;=0.05/3\u0026thinsp;=\u0026thinsp;0.0167.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u0026lowast;\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0167 compared with T1; # \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0167 compared with T0.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eb MD Unit:\u0026times;10⁻\u0026sup3; mm\u0026sup2;/s。\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eBold values indicate statistical significance in the overall repeated measures ANOVA (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA: Schematic diagram of gross anatomy of the normal frontal lobe;\u003c/p\u003e \u003cp\u003eB: Three-dimensional reconstruction of white matter fiber tracts associated with the normal frontal lobe;\u003c/p\u003e \u003cp\u003eC: Three-dimensional reconstruction of white matter fiber tracts associated with the frontal lobe in a patient with frontal lobe glioma before radiotherapy;\u003c/p\u003e \u003cp\u003eD: Three-dimensional reconstruction of white matter fiber tracts associated with the frontal lobe in the same patient after radiotherapy.\u003c/p\u003e \u003cp\u003eMorphological differences in the frontal lobe-associated white matter fiber tracts can be observed before and after radiotherapy.\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eWith the continuous advancement of comprehensive treatment strategies for glioma, patient survival has gradually extended; consequently, treatment-related cognitive dysfunction has become a critical factor affecting long-term quality of life and social functional recovery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In this study, we employed DTI fiber tractography to longitudinally evaluate cognitive-related white matter fiber tracts in patients with frontal lobe glioma before and after radiochemotherapy. The results showed that MoCA total scores at 6 months after radiochemotherapy were significantly lower than those before surgery and at 1 month postoperatively. At the white matter fiber tract level, microstructural damage was observed in the SLF, Cg, and CC. Specifically, the SLF and CC exhibited decreased FA accompanied by increased MD, while the Cg primarily showed decreased FA. Further correlation analysis revealed that CC damage was associated with global cognitive decline, SLF damage was associated with executive function decline, and Cg damage was associated with memory function decline. These findings suggest that cognitive dysfunction after radiochemotherapy in patients with frontal lobe glioma is not merely attributable to focal damage to a single brain region, but may instead be related to disruption of the cognitive-related white matter connection network.\u003c/p\u003e \u003cp\u003eIn the present study, patients mainly exhibited a decline in global cognitive function after radiochemotherapy, accompanied by a trend toward impairment in executive and memory functions, which is generally consistent with the functional anatomical characteristics of the frontal lobe [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Meanwhile, the decline in memory function may not be solely attributed to local gray matter damage but may also result from reduced information integration efficiency between the frontal lobe and the limbic system [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Previous studies have often observed treatment-related injury at the level of whole-brain white matter or local brain regions; however, the present study further localized the abnormalities to specific white matter fiber tracts, suggesting that cognitive impairment may not merely reflect functional decline in localized brain regions, but rather represents a comprehensive manifestation of damage to key connection pathways within higher-order cognitive networks.\u003c/p\u003e \u003cp\u003eFrom a network perspective, the changes in the SLF, Cg, and CC exhibit a relatively clear structure\u0026ndash;function correspondence. The SLF is an important structural pathway of the frontoparietal control network, involved in higher-order cognitive activities such as executive control, attentional switching, and working memory [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]; its damage correlated with declines in visuospatial and executive function, suggesting that the decline in executive control ability after radiochemotherapy may be closely related to impaired frontoparietal connectivity. The Cg connects the frontal lobe, cingulate gyrus, and regions associated with the limbic system, playing a key role in memory retrieval, internal information integration, and cognitive control [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]; its abnormalities correlated with delayed recall decline, indicating that treatment-related memory impairment may be associated with disruption of frontal\u0026ndash;limbic connections. As the major pathway for interhemispheric information integration [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], the CC correlated with changes in MoCA total score, suggesting that damage to this tract may have a broader impact extending beyond a single cognitive domain. Thus, the observed findings do not simply reflect scattered abnormalities in several fiber tracts, but rather point to a selective vulnerability of key connecting edges within the higher-order frontal cognitive network.\u003c/p\u003e \u003cp\u003eIt is noteworthy that in this study, white matter microstructural abnormalities predominantly emerged at 6 months after radiochemotherapy, whereas changes at 1 month postoperatively were relatively subtle, suggesting a certain degree of delayed onset and cumulative nature of cognitive impairment and white matter alterations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In the early postoperative period, local tissue edema, surgical site repair, and neural functional compensation may coexist, obscuring the full manifestation of structural and functional changes. As the effects of radiochemotherapy accumulate progressively, pathological processes such as oligodendrocyte injury, demyelination, microvascular damage, and chronic neuroinflammation further develop [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], ultimately manifesting as more pronounced FA decrease and MD increase at the 6-month follow-up. This time-dependent evolution of cognitive dysfunction indicates a continuously progressive process, highlighting the need to adjust treatment strategies accordingly\u0026mdash;including risk identification, radiotherapy optimization, and rehabilitation intervention\u0026mdash;based on this temporal pattern.\u003c/p\u003e \u003cp\u003eFurthermore, it is equally noteworthy that not all white matter fiber tracts exhibited abnormalities. In this study, the uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), and arcuate fasciculus (AF), which are associated with language function, as well as the corticospinal tract (CST) serving as a negative control, showed no significant abnormalities across the three time points. In contrast, damage was more prominent in the SLF, Cg, and CC, suggesting that white matter injury after radiochemotherapy does not occur homogenously throughout the brain, but rather preferentially involves the key pathways closely associated with higher-order cognitive functions of the frontal lobe [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In other words, white matter damage following radiochemotherapy may exhibit a pattern of preferential involvement of cognitive-related pathways.\u003c/p\u003e \u003cp\u003eThis study also found that the proportion of partial resection was higher in the cognitive decline group, suggesting that the extent of resection may be associated with cognitive outcomes. Compared with complete resection, patients with partial resection had a larger residual tumor burden, which may exert persistent mass effects, infiltrative impacts, and interference with white matter fiber tract integrity on the frontal local network, while also reducing postoperative neural functional compensation capacity, thereby increasing the risk of subsequent cognitive decline [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This finding suggests that maximizing the extent of safe resection while ensuring neurological safety may help improve long-term cognitive outcomes in patients. However, the relationship between the extent of resection and cognitive outcomes remains influenced by multiple factors, including tumor location, infiltration range, intraoperative assistance, and individual brain functional reserve, warranting the use of more surgical modalities to achieve maximal safe resection.\u003c/p\u003e \u003cp\u003eAlthough the radiation dose was slightly higher in the cognitive decline group than in the stable group, the difference was not statistically significant, suggesting that the radiation dose alone was not the primary factor contributing to cognitive decline in this study. However, this finding does not negate the adverse effects of radiotherapy; rather, it suggests that cognitive impairment likely results from the combined effects of \u0026ldquo;indirect effects of treatment (such as microstructural damage to white matter fiber tracts) + residual tumor burden\u0026thinsp;+\u0026thinsp;disruption of network connections caused by surgery.\u0026rdquo; Among these, radiotherapy may serve as the core structural basis for the selective damage to cognitive-related white matter fiber tracts, such as the SLF, Cg, and CC, by inducing oligodendrocyte apoptosis, demyelination, and chronic neuroinflammation [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], ultimately leading to declines in executive and memory functions. However, further research is needed to confirm this.\u003c/p\u003e \u003cp\u003eFrom the perspective of imaging metrics, the changes in cognitive function in this study were significantly correlated primarily with ΔFA, whereas ΔMD showed no significant correlation with changes in MoCA total score or scores in any cognitive domain. This suggests that FA may be more sensitive to treatment-related microstructural abnormalities in white matter. A decrease in FA typically reflects reduced fiber alignment and compromised structural integrity, allowing early detection of microstructural disorganization in white matter fiber tracts [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]; in contrast, although MD increased in some fiber tracts, its correspondence with cognitive function changes was relatively limited. Based on these findings, DTI, particularly the FA parameter, is closely associated with cognitive function changes in patients with frontal lobe glioma after radiochemotherapy and may serve as an objective imaging reference for assessing treatment-related cognitive impairment.\u003c/p\u003e \u003cp\u003eThe findings of this study have certain clinical implications. First, while ensuring tumor control, postoperative radiotherapy planning may consider enhancing the protection of cognitive-related white matter fiber tracts, particularly the SLF, Cg, and CC, to minimize high-dose irradiation damage to these critical connection pathways. Second, during follow-up, in addition to monitoring tumor control and conventional imaging changes, dynamic assessment using MoCA and DTI in patients at high risk for cognitive impairment may facilitate early identification of treatment-related cognitive injury. Third, early screening and intervention targeting executive and memory functions may help improve patients\u0026lsquo; long-term quality of life and social functional recovery.\u003c/p\u003e \u003cp\u003eIn addition, this study has several limitations. First, the sample size was relatively small, and the follow-up duration was only 6 months, which may not be sufficient to fully elucidate long-term cognitive outcomes and the dynamic evolution of white matter damage. Second, the independent effects of radiotherapy and chemotherapy were not further distinguished, and more detailed neuropsychological assessments and multimodal imaging validation are lacking. Future studies with larger sample sizes, longer follow-up periods, and dosimetric analysis are needed to further develop predictive models and intervention strategies for treatment-related cognitive impairment. Nevertheless, this study provides insights into the structural basis of cognitive dysfunction in patients with frontal lobe glioma after radiochemotherapy from the perspective of white matter fiber tract networks, offering imaging evidence to support the optimization of comprehensive treatment strategies, enhancement of cognitive protection, and improvement of patients\u0026rsquo; quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiffusion tensor imaging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMoCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMontreal Cognitive Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFractional anisotropy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMean diffusivity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSLF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSuperior longitudinal fasciculus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCg\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCingulum\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCorpus callosum\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUncinate fasciculus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIFOF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInferior fronto-occipital fasciculus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArcuate fasciculus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCorticospinal tract\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIMRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensity-modulated radiotherapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTMZ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTemozolomide.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of The First Affiliated Hospital of Jishou University (Approval No. XXZRY-LCKY-2025-16). The Ethics Committee waived the requirement for informed consent because: (1) the study posed minimal risk; (2) all data were analyzed anonymously from existing medical records; (3) no additional interventions were performed; and (4) obtaining consent was impracticable due to the retrospective design. All patient data were de-identified prior to analysis to ensure confidentiality.\u003c/p\u003e\n\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person\u0026rsquo;s data in any form (including individual details, images, or videos).\u003c/p\u003e\n\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to patient privacy and ethical restrictions, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Major Research Project of the National Key Clinical Specialty of China (Grant No. 20230309), the Natural Science Foundation of Hunan Province, China (Grant No. 2024JJ7558), and the Scientific Research Project of Jishou University, China (Grant No. Jdzd24049).\u003c/p\u003e\n\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eJia Chen: Conceptualization, Methodology, Formal analysis, Writing - Original Draft. Xiaoping Li: Data curation, Investigation, Visualization. Zhi Tian: Data curation, Investigation. Chunhai Huang: Data curation, Validation. Yi Wan: Software, Validation. Zhao Wang: Conceptualization, Resources, Writing - Review \u0026amp; Editing, Supervision, Funding acquisition. All authors read and approved the final manuscript.\u003c/p\u003e\n\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to the Jiaolong Deshui JLDS Anatomy Laboratory 6.0 for providing excellent anatomical equipment and facilities. We also thank the donor cadavers for providing high-quality cranial and fiber tract anatomical specimens. Additionally, we acknowledge Professor Fang-Cheng Yeh from Stanford University for providing the open-source DSI Studio software, which enabled individualized fiber tract tracking in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePuglisi G, Howells H, Sciortino T, Leonetti A, Rossi M, Nibali MC, et al. Frontal pathways in cognitive control: direct evidence from intraoperative stimulation and diffusion tractography. Brain. 2019;142(9):2601\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/brain/awz178\u003c/span\u003e\u003cspan address=\"10.1093/brain/awz178\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson DR, Sawyer AM, Meyers CA, O\u0026rsquo;Neill BP, Wefel JS. Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma. Neuro-Oncol. 2012;14:808\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/neuonc/nos082\u003c/span\u003e\u003cspan address=\"10.1093/neuonc/nos082\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Kessel E, Huenges Wajer IMC, Ruis C, Seute T, Fonville S, De Vos FYFL, et al. Cognitive impairments are independently associated with shorter survival in diffuse glioma patients. J Neurol. 2021;268:1434\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00415-020-10303-w\u003c/span\u003e\u003cspan address=\"10.1007/s00415-020-10303-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang T, Mao Y, Ma W, Mao Q, You Y, Yang X, et al. CGCG clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett. 2016;375:263\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.canlet.2016.01.024\u003c/span\u003e\u003cspan address=\"10.1016/j.canlet.2016.01.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaldbo-Classen L, Amidi A, Lukacova S, Wu LM, Oettingen GV, Lassen-Ramshad Y, et al. Cognitive impairment following radiation to hippocampus and other brain structures in adults with primary brain tumours. Radiother Oncol. 2020;148:1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.radonc.2020.03.023\u003c/span\u003e\u003cspan address=\"10.1016/j.radonc.2020.03.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAznar MC, Davey A, Wilson LJ, Osorio EV, Bulbeck H, Thomson A, et al. Cognitive outcomes after radiotherapy for medulloblastoma: a voxel-based analysis. Int J Radiat Oncol. 2026. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijrobp.2026.03.007\u003c/span\u003e\u003cspan address=\"10.1016/j.ijrobp.2026.03.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. S036030162600492X.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi X, Ding Z. Cognitive dysfunction induced by cranial radiotherapy: mechanisms and therapeutic methods. Brain Res Bull. 2024;218:111106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.brainresbull.2024.111106\u003c/span\u003e\u003cspan address=\"10.1016/j.brainresbull.2024.111106\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Oppong PKJ, Kitagawa M, Aoyama H, Onodera S, Terae S, et al. DTI Histogram and Texture Features as Early Predictors of Post-Radiotherapy Cognitive Decline. Appl Sci. 2025;15:6794. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/app15126794\u003c/span\u003e\u003cspan address=\"10.3390/app15126794\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKłos J, Dijkstra H, Van Der Weide HL, Potze JH, Sinnige PF, Ng Wei Siang K, et al. Relationship between DTI-MRI derived metrics and radiotherapy dose range in the contralateral cerebrum in lower grade glioma. Front Oncol. 2025;15:1406340. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fonc.2025.1406340\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2025.1406340\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Z-C, Yin C-D, Yeh F-C, Xue B-W, Song X-Y, Li G, et al. A preliminary study on corticospinal tract morphology in incidental and symptomatic insular low-grade glioma: implications for post-surgical motor outcomes. NeuroImage Clin. 2023;40:103521. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nicl.2023.103521\u003c/span\u003e\u003cspan address=\"10.1016/j.nicl.2023.103521\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKocher M, Jockwitz C, Lohmann P, Stoffels G, Filss C, Mottaghy FM, et al. Lesion-Function Analysis from Multimodal Imaging and Normative Brain Atlases for Prediction of Cognitive Deficits in Glioma Patients. Cancers. 2021;13:2373. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/cancers13102373\u003c/span\u003e\u003cspan address=\"10.3390/cancers13102373\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWende T, G\u0026uuml;resir E, Wach J, Vychopen M, Hoffmann A, Prasse G, et al. Radiomic white matter parameters of functional integrity of the corticospinal tract in high-grade glioma. Sci Rep. 2024;14:12891. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-024-63813-2\u003c/span\u003e\u003cspan address=\"10.1038/s41598-024-63813-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung JS, Morshed RA, Hervey-Jumper SL, Berger MS. The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions. Neuro-Oncol. 2023;25:2117\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/neuonc/noad133\u003c/span\u003e\u003cspan address=\"10.1093/neuonc/noad133\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang T, Nam D-H, Ram Z, Poo W, Wang J, Boldbaatar D, et al. Updated clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett. 2026;640:218185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.canlet.2025.218185\u003c/span\u003e\u003cspan address=\"10.1016/j.canlet.2025.218185\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeh F-C, Verstynen TD, Wang Y, Fern\u0026aacute;ndez-Miranda JC, Tseng W-YI. Deterministic Diffusion Fiber Tracking Improved by Quantitative Anisotropy. Zhan W, editor. PLoS ONE. 2013;8:e80713. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0080713\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0080713\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMori S, Oishi K, Jiang H, Jiang L, Li X, Akhter K, et al. Stereotaxic white matter atlas based on diffusion tensor imaging in an ICBM template. NeuroImage. 2008;40:570\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.neuroimage.2007.12.035\u003c/span\u003e\u003cspan address=\"10.1016/j.neuroimage.2007.12.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Kessel E, Baumfalk AE, Van Zandvoort MJE, Robe PA, Snijders TJ. Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment. J Neurooncol. 2017;134:9\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11060-017-2503-z\u003c/span\u003e\u003cspan address=\"10.1007/s11060-017-2503-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Bouc R, Garcin B, Urbanski M, Volle E, Dubois B, Levy R. Anatomy and Disorders of Frontal Lobe Functions: Fundamental Functions. Encycl Behav Neurosci 2nd Ed [Internet]. Elsevier; 2022 [cited 2026 Mar 22]. pp. 266\u0026ndash;79. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/B978-0-12-819641-0.00065-7\u003c/span\u003e\u003cspan address=\"10.1016/B978-0-12-819641-0.00065-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhasraw M, Lassman AB. Late neurocognitive decline after radiotherapy for low-grade glioma. Nat Rev Neurol. 2009;5:646\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nrneurol.2009.194\u003c/span\u003e\u003cspan address=\"10.1038/nrneurol.2009.194\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLa Corte V, Sperduti M, Malherbe C, Vialatte F, Lion S, Gallarda T, et al. Cognitive Decline and Reorganization of Functional Connectivity in Healthy Aging: The Pivotal Role of the Salience Network in the Prediction of Age and Cognitive Performances. Front Aging Neurosci [Internet]. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fnagi.2016.00204\u003c/span\u003e\u003cspan address=\"10.3389/fnagi.2016.00204\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [cited 2026 Mar 22];8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakajima R, Kinoshita M, Shinohara H, Nakada M. The superior longitudinal fascicle: reconsidering the fronto-parietal neural network based on anatomy and function. Brain Imaging Behav. 2020;14:2817\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11682-019-00187-4\u003c/span\u003e\u003cspan address=\"10.1007/s11682-019-00187-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng Y, Bo B, Wang D, Liu Y, Shi L, Gilbert SJ, et al. Microstructural organization of superior longitudinal fasciculus and cingulum bundle support metacognition driven cognitive offloading. Sci Rep. 2025;15:33247. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-025-18631-5\u003c/span\u003e\u003cspan address=\"10.1038/s41598-025-18631-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRolls ET. The cingulate cortex and limbic systems for emotion, action, and memory. Brain Struct Funct. 2019;224:3001\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00429-019-01945-2\u003c/span\u003e\u003cspan address=\"10.1007/s00429-019-01945-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKollenburg L, Arnts H, Green A, Strauss I, Vinke S, Kurt E. The cingulum: anatomy, connectivity and what goes beyond. Brain Commun. 2024;7:fcaf048. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/braincomms/fcaf048\u003c/span\u003e\u003cspan address=\"10.1093/braincomms/fcaf048\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhatt RR, Gadewar SP, Shetty A, Ba Gari I, Haddad E, Javid S et al. The Genetic Architecture of the Human Corpus Callosum and its Subregions [Internet]. Neuroscience; 2024 [cited 2026 Mar 22]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1101/2024.07.22.603147\u003c/span\u003e\u003cspan address=\"10.1101/2024.07.22.603147\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMooshagian E. Anatomy of the Corpus Callosum Reveals Its Function. J Neurosci. 2008;28:1535\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1523/JNEUROSCI.5426-07.2008\u003c/span\u003e\u003cspan address=\"10.1523/JNEUROSCI.5426-07.2008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDropcho EJ. Neurotoxicity of Radiation Therapy. Neurol Clin. 2010;28:217\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ncl.2009.09.008\u003c/span\u003e\u003cspan address=\"10.1016/j.ncl.2009.09.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWitzmann K, Raschke F, Troost EGC. MR Image Changes of Normal-Appearing Brain Tissue after Radiotherapy. Cancers. 2021;13:1573. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/cancers13071573\u003c/span\u003e\u003cspan address=\"10.3390/cancers13071573\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShamsesfandabadi P, Patel A, Liang Y, Shepard M, Wegner R. Radiation-Induced Cognitive Decline: Challenges and Solutions. Cancer Manag Res 2024;Volume 16:1043\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/CMAR.S441360\u003c/span\u003e\u003cspan address=\"10.2147/CMAR.S441360\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall WA, Pugh SL, Wefel JS, Armstrong TS, Gilbert MR, Brachman DG, et al. Influence of Residual Disease Following Surgical Resection in Newly Diagnosed Glioblastoma on Clinical, Neurocognitive, and Patient Reported Outcomes. Neurosurgery. 2019;84:66\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/neuros/nyy003\u003c/span\u003e\u003cspan address=\"10.1093/neuros/nyy003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q, Xiao F, Qi F, Song X, Yu Y. Risk Factors for Cognitive Impairment in High-Grade Glioma Patients Treated with Postoperative Radiochemotherapy. Cancer Res Treat. 2020;52:586\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4143/crt.2019.242\u003c/span\u003e\u003cspan address=\"10.4143/crt.2019.242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurns TC, Awad AJ, Li MD, Grant GA. Radiation-induced brain injury: low-hanging fruit for neuroregeneration. Neurosurg Focus. 2016;40:E3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3171/2016.2.FOCUS161\u003c/span\u003e\u003cspan address=\"10.3171/2016.2.FOCUS161\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLucic M, Djan I, Sveljo O, Lucic S, Ivanov O, Bjelan M, et al. Multiparametric structural imaging biomarkers of early white matter microstructural changes during and after glioblastoma chemoradiotherapy: Diffusion tensor imaging and diffusion kurtosis imaging. Vojnosanit Pregl. 2026;83:21\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2298/VSP250525083L\u003c/span\u003e\u003cspan address=\"10.2298/VSP250525083L\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Glioma, Frontal lobe, Radiochemotherapy, Cognitive dysfunction, Diffusion tensor imaging, White matter fiber tracts","lastPublishedDoi":"10.21203/rs.3.rs-9225199/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9225199/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo investigate the structural basis of white matter fiber tracts in cognitive dysfunction following radiochemotherapy in patients with frontal lobe glioma.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 40 patients with frontal lobe glioma who underwent surgery and postoperative concurrent radiochemotherapy in First Affiliated Hospital of Jishou University from June 2023 to June 2025 were enrolled. Montreal Cognitive Assessment (MoCA) and diffusion tensor imaging (DTI) were performed at three time points: preoperative (T0), 1 month postoperative (T1), and 6 months post-radiochemotherapy (T2). Fiber tractography was used to extract fractional anisotropy (FA) and mean diffusivity (MD) values of the superior longitudinal fasciculus (SLF), cingulum (Cg), corpus callosum (CC), uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), and corticospinal tract (CST). Cognitive scores and DTI parameters were compared across time points, and correlations between changes in key fiber tract parameters and changes in MoCA total score and cognitive domain scores were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMoCA total scores differed significantly across time points (F\u0026thinsp;=\u0026thinsp;4.892, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), with scores at T2 being lower than those at T1 and T0. Visuospatial/executive function and delayed recall showed statistically significant overall differences across time points, but after Bonferroni correction, pairwise comparisons did not reach statistical significance (P\u0026thinsp;\u0026gt;\u0026thinsp;0.0167), only suggesting a declining trend. FA values of the SLF, Cg, and CC showed significant differences across the three time points, with significant decreases at T2 compared with T1; MD values of the SLF and CC also showed significant differences across time points, with significant increases at T2 compared with T1. FA and MD values of the UF, IFOF, AF, and CST showed no significant differences across time points. Correlation analysis showed that ΔFA of the CC was positively correlated with ΔMoCA total score, ΔFA of the SLF was positively correlated with changes in visuospatial/executive function scores, and ΔFA of the Cg was positively correlated with changes in delayed recall scores; ΔMD of each fiber tract showed no significant correlations with changes in MoCA total score or cognitive domain scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCognitive dysfunction after radiochemotherapy for frontal lobe glioma is closely associated with damage to cognitive-related white matter connection networks, predominantly involving the SLF (executive function), Cg (memory function), and CC (overall cognitive function).\u003c/p\u003e","manuscriptTitle":"Diffusion Tensor Imaging Study of Cognitive Dysfunction After Radiochemotherapy for Frontal Lobe Glioma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 05:37:44","doi":"10.21203/rs.3.rs-9225199/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"193605035377030637779411695709988017474","date":"2026-04-29T03:43:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T09:30:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-26T19:30:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-03T05:15:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T22:39:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2026-04-02T22:35:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ddbf4fae-6891-4ef0-ad8d-616758736074","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T05:37:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 05:37:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9225199","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9225199","identity":"rs-9225199","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}