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

Survivors of pediatric brain tumour patients are at high risk of cognitive morbidity. There is clinical benefit in being able to reliably predict, at the individual patient level, whether a patient will experience these difficulties or not, the degree of impairment, and the domains affected. Whilst established risk factors exist, quantitative analysis of MRI could provide added predictive value towards this goal, above and beyond existing clinical risk models. The current systematic review aims to answer the question; Do MRI markers predict future cognitive functioning in pediatric brain tumour survivors?. Studies of pediatric brain tumour patients which test the value of MRI variables in predicting later neuropsychological outcomes were searched up to July 2022. Only included were studies where MRI scans were acquired at an earlier timepoint and used to predict a child's performance on cognitive tests at a later timepoint. Surprisingly few studies were identified by the search process which specifically investigated MRI measures of cerebellar and white matter damage as features in predicting cognitive outcomes. However, the important finding of this review is that the current literature is limited and those identified had small sample sizes and were rated as poor quality for the purposes of prediction. Overall, current findings are at high risk of bias and thus the quality and impact of conclusions are limited. Given the significant impact for this clinical population that predictive models would enable, the current review affirms the need for a call-to-action for medical imaging researchers in pediatric neuro-oncology. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement DGK is funded by a post-doctoral award from Aston University College of Health and Life Sciences, awarded to JN & DGK. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Source data is the records of publicly available research studies, openly available before the initiation of the research/systematic review. Records available via declared systematic review methodologies. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data extracted from included studies is publicly available and found (in its entirety) in Table 2. Lists of reviewed studied, at each stage of the PRISMA flowchart are available from the authors upon reasonable request.