Figure 1.

The differences in the white (WM; (A–C) and gray matters (GM; (D) between germ cell tumor (GCT; n = 20) survivors and healthy age, sex-matched controls (n = 14) were investigated using diffusion metrics, namely mean diffusivity (MD), fractional anisotropy (FA), and mean kurtosis (MK), obtained from diffusional kurtosis imaging (DKI). Region-of-interest (ROI) measurement of the cortical and subcortical regions, from the Automated anatomical labeling (AAL) atlas, and major WM tracts, from the Johns Hopkins white matter atlas, were performed. The brain regions that showed statistically significant difference in diffusion metrics between GCT and healthy controls were shown (P < 0.01 in yellow; P < 0.05 in green). As compared to healthy controls, ROI analyses of the WM showed that the MD (A) of GCT survivors in the cerebral peduncle (CP), superior corona radiata (SCR), anterior limb of internal capsule (al_IC), and superior fronto-occipital fasciculus (SFOF) were higher; the MK (B) in the superior longitudinal fasciculus (SLF), SCR, and al_IC were lower; and the FA (C) in the posterior corona radiata (PCR), posterior thalamic radiation (PTR), and ac_IC were lower. Region-of-interest analysis of the GM (D) showed that the MD of GCT in fusiform (Fu), inferior temporal gyrus (ITG), middle temporal gyrus (MTG), superior temporal pole (STP), superior temporal gyrus (STG), amygdala (AM), insular (In), lingual gyrus (LG), rolandic operculum (RO), anterior cingulum (AC), middle cingulum (MC), posterior cingulum (PC), calcarine (Cal), cuneus (Cu), precentral gyrus (pC), postcentral gyrus (PC), supramarginal gyrus (SG), frontal inferior operculum (FIO), and inferior frontal triangularis (IFT) were significantly higher than those of healthy control.