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Jin L, Lu D, Yan F, Han J, Wei P, Zhou Y, Wang Y, Shan Y, Zhao G. A disease warranting attention from neurosurgeons: primary central nervous system post-transplant lymphoproliferative disorder. Front Neurol 2024; 15:1392691. [PMID: 38813246 PMCID: PMC11133574 DOI: 10.3389/fneur.2024.1392691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024] Open
Abstract
Background Primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD) is a rare condition, posing diagnostic and treatment challenges, with histological biopsy essential for diagnosis. Standardized treatment protocols are lacking. This disease requires urgent attention due to the increasing number of organ transplant surgeries and the use of immunosuppressive agents. Methods From 2020 to 2023, our center diagnosed five patients with PCNS-PTLD. We reviewed their clinical records and conducted a comprehensive analysis of 22 literatures on PCNS-PTLD cases following renal transplantation or allogeneic hematopoietic stem cell transplantation (HSCT). Results Four patients had previously received a kidney transplant, one had undergone allogeneic HSCT. The median time from the last transplant surgery to the diagnosis of PCNS-PTLD differs between kidney transplant (21.5 years) and allogeneic HSCT (9 months). Common symptoms included motor weakness (n = 4), headache (n = 2), confusion (n = 2), and nausea (n = 2), with ring-enhancing (n = 5), typically solitary (n = 3) and supratentorial (n = 3) lesions on imaging. Diagnosis involved robot-assisted stereotactic brain biopsy (n = 4) or craniotomy (n = 1), all showing Epstein-Barr virus and CD20 positivity. Most cases (n = 4) were monomorphic diffuse large B-cell lymphoma. Treatment included rituximab (n = 3), surgical resection (n = 2), zanubrutinib (n = 1), whole-brain radiation (n = 1), and methotrexate (n = 1). At the last follow-up, the median duration of follow-up for all patients was 19 months. During this time, 3 patients had died and 2 patients were still alive. Conclusion In patients with a history of kidney transplantation or allogeneic HSCT who are on long-term immunosuppressive therapy, any neurological symptoms, particularly the presence of supratentorial ring-enhancing masses in the brain on imaging, whether solitary or multiple, should raise high suspicion for this disease, warranting a timely brain biopsy. Additionally, we found that besides reducing immunosuppressants, zanubrutinib may be a potential, safe, and effective treatment for this condition. Moreover, post-surgical administration of rituximab in conjunction with whole-brain radiotherapy also appears to be a potentially safe and effective approach.
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Affiliation(s)
- Lei Jin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Di Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Jinkun Han
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Yiqiang Zhou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yaming Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
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Cui L, Qin Z, Sun S, Feng W, Hou M, Yu D. Diffusion-weighted imaging-based radiomics model using automatic machine learning to differentiate cerebral cystic metastases from brain abscesses. J Cancer Res Clin Oncol 2024; 150:132. [PMID: 38492096 PMCID: PMC10944436 DOI: 10.1007/s00432-024-05642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES To develop a radiomics model based on diffusion-weighted imaging (DWI) utilizing automated machine learning method to differentiate cerebral cystic metastases from brain abscesses. MATERIALS AND METHODS A total of 186 patients with cerebral cystic metastases (n = 98) and brain abscesses (n = 88) from two clinical institutions were retrospectively included. The datasets (129 from institution A) were randomly portioned into separate 75% training and 25% internal testing sets. Radiomics features were extracted from DWI images using two subregions of the lesion (cystic core and solid wall). A thorough image preprocessing method was applied to DWI images to ensure the robustness of radiomics features before feature extraction. Then the Tree-based Pipeline Optimization Tool (TPOT) was utilized to search for the best optimized machine learning pipeline, using a fivefold cross-validation in the training set. The external test set (57 from institution B) was used to evaluate the model's performance. RESULTS Seven distinct TPOT models were optimized to distinguish between cerebral cystic metastases and abscesses either based on different features combination or using wavelet transform. The optimal model demonstrated an AUC of 1.00, an accuracy of 0.97, sensitivity of 1.00, and specificity of 0.93 in the internal test set, based on the combination of cystic core and solid wall radiomics signature using wavelet transform. In the external test set, this model reached 1.00 AUC, 0.96 accuracy, 1.00 sensitivity, and 0.93 specificity. CONCLUSION The DWI-based radiomics model established by TPOT exhibits a promising predictive capacity in distinguishing cerebral cystic metastases from abscesses.
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Affiliation(s)
- Linyang Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
- Department of Radiology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, 264400, Shandong, China
| | - Zheng Qin
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Siyuan Sun
- Qilu Pharmaceutical Co., Ltd, Jinan, 250100, Shandong, China
| | - Weihua Feng
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Mingyuan Hou
- Department of Imaging, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, 264200, Shandong, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Garg RK, Paliwal V, Pandey S, Uniyal R, Agrawal KK. The etiological spectrum of multiple ring-enhancing lesions of the brain: a systematic review of published cases and case series. Neurol Sci 2024; 45:515-523. [PMID: 37768475 DOI: 10.1007/s10072-023-07083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Multiple ring-enhancing lesions of the brain are enigmatic neuroimaging abnormality. In this systematic review, we evaluated the etiological spectrum of these lesions. METHODS This systematic review adhered to the PRISMA guidelines. We searched PubMed, Embase, Scopus, and Google Scholar up until 15 June 2023. We included case reports and case series. Quality evaluation of each case was based on selection, ascertainment, causality, and reporting. The extracted information included demographic characteristics, clinical features, type and number of multiple enhancing brain lesions, diagnostic procedures, final diagnoses, treatments, and patient outcomes. PROTOCOL REGISTRATION PROSPERO CRD42023437081. RESULTS We analyzed 156 records representing 161 patients, 60 of whom were immunocompromised. The mean age was 42.6 years, and 67% of patients experienced symptoms for up to 1 month. A higher proportion of immunocompromised patients (42% vs. 30%) exhibited encephalopathy. Chest or CT thorax abnormalities were reported in 27.3% of patients, while CSF abnormalities were found in 31.7%, more frequently among the immunocompromised. Definitive diagnoses were established via brain biopsy, aspiration, or autopsy in 60% of cases, and through CSF examination or other ancillary tests in 40% of cases. Immunocompromised patients had a higher incidence of Toxoplasma gondii infection and CNS lymphoma, while immunocompetent patients had a higher incidence of Mycobacterium tuberculosis infection and immune-mediated and demyelinating disorders. The improvement rate was 74% in immunocompetent patients compared to 52% in the immunocompromised group. CONCLUSION Multiple ring-enhancing lesions of the brain in immunocompromised patients are more frequently caused by Toxoplasma gondii infections and CNS lymphoma. Conversely, among immunocompetent patients, Mycobacterium tuberculosis infection and immune-related demyelinating conditions are common.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, 226003, India.
| | - Vimal Paliwal
- Department of Neurology, Sanjay Gandhi Institute of Medical Sciences, Lucknow, 226001, India
| | - Shweta Pandey
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
| | - Ravi Uniyal
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
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Patel A, More B, Rege I, Ranade D. Clinical diagnosis and management of multiple cerebral ring-enhancing lesions-study of 50 patients at a tertiary healthcare center. J Cancer Res Ther 2024; 20:112-117. [PMID: 38554307 DOI: 10.4103/jcrt.jcrt_1456_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/04/2022] [Indexed: 04/01/2024]
Abstract
AIM OF THE STUDY Multiple ring-enhancing lesions are commonly experienced group of brain pathologies which we come across in day-to-day practice. Clinical symptoms in these lesions are quite non-specific, and hence, it is difficult to reach a final diagnosis. However, these lesions have a varied group of differential diagnosis and it is sometimes difficult to have an accurate diagnosis on conventional MRI. This article was written with the objective of discussing the demographical study and etiology, clinical diagnosis and management for these patients. MATERIALS AND METHODS It is a prospective study carried out at the Department of Neurosurgery, Dr. D Y Patil Medical College and Hospital, Pune, from September 2019 to August 2022 and included 50 patients who presented to us multiple ring-enhancing brain lesions. RESULTS In our study, 50 patients between age (1-70 years) with multiple ring-enhancing lesions were analyzed. Majority of the patients were between age group 30-39 years. Males (76%) were majority in our study than females (24%). Most common pathology was primary neoplasm (glioma) and metastasis, followed by nine patients of pyogenic abscess and tuberculosis each. Neurocysticercosis was seen in eight patients and three patients were diagnosed with CNS lymphoma. Most of our patients presented with headache (38 patients) and a subset of patients had associated seizures (28 patients). Two patients with primary neoplasm were diagnosed to have WHO grade 3 glioma and seven patients were diagnosed to have WHO grade 4 glioma. Glioblastoma multiforme presented as multifocal and multicentric lesions. Among the patients with primary neoplasm, three patients underwent stereotactic biopsy for diagnosis and the rest of seven patients underwent maximum safe resection followed by chemotherapy and radiotherapy. Ten patients were diagnosed with metastatic lesions, among them six patients underwent stereotactic biopsy for histopathological diagnosis and immunohistochemistry, and rest of the patients were managed on the basis of the primary lesion. Five patients were immune-compromised, among them two patients presented with abscess and three patients presented with primary neoplastic lesion. Thirty-six patients underwent biopsy, among them seven patients underwent frameless, seven patients underwent frame stereotactic biopsy, and the rest 22 patients underwent excision biopsy. CONCLUSION Multiple ring-enhancing lesions of brain pose a challenge in terms of achieving an accurate diagnosis and planning further treatment. It is of utmost importance to have a diagnosis in mind based on radiological investigations, so that surgical intervention can be planned accordingly be it by invasive or minimal invasive techniques. An idea toward the diagnosis also helps in prognosticating these patients which could avoid costly whole-body scans and unnecessary surgical intervention.
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Affiliation(s)
- Ankit Patel
- Department of Neurosurgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
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Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
SCOPE These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. METHODS Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Zhu FY, Sun YF, Yin XP, Zhang Y, Xing LH, Ma ZP, Xue LY, Wang JN. Using machine learning-based radiomics to differentiate between glioma and solitary brain metastasis from lung cancer and its subtypes. Discov Oncol 2023; 14:224. [PMID: 38055122 DOI: 10.1007/s12672-023-00837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To establish a machine learning-based radiomics model to differentiate between glioma and solitary brain metastasis from lung cancer and its subtypes, thereby achieving accurate preoperative classification. MATERIALS AND METHODS A retrospective analysis was conducted on MRI T1WI-enhanced images of 105 patients with glioma and 172 patients with solitary brain metastasis from lung cancer, which were confirmed pathologically. The patients were divided into the training group and validation group in an 8:2 ratio for image segmentation, extraction, and filtering; multiple layer perceptron (MLP), support vector machine (SVM), random forest (RF), and logistic regression (LR) were used for modeling; fivefold cross-validation was used to train the model; the validation group was used to evaluate and assess the predictive performance of the model, ROC curve was used to calculate the accuracy, sensitivity, and specificity of the model, and the area under curve (AUC) was used to assess the predictive performance of the model. RESULTS The accuracy and AUC of the MLP differentiation model for high-grade glioma and solitary brain metastasis in the validation group was 0.992, 1.000, respectively, while the sensitivity and specificity were 1.000, 0.968, respectively. The accuracy and AUC for the MLP and SVM differentiation model for high-grade glioma and small cell lung cancer brain metastasis in the validation group was 0.966, 1.000, respectively, while the sensitivity and specificity were 1.000, 0.929, respectively. The accuracy and AUC for the MLP differentiation model for high-grade glioma and non-small cell lung cancer brain metastasis in the validation group was 0.982, 0.999, respectively, while the sensitivity and specificity were 0.958, 1.000, respectively. CONCLUSION The application of machine learning-based radiomics has a certain clinical value in differentiating glioma from solitary brain metastasis from lung cancer and its subtypes. In the HGG/SBM and HGG/NSCLC SBM validation groups, the MLP model had the best diagnostic performance, while in the HGG/SCLC SBM validation group, the MLP and SVM models had the best diagnostic performance.
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Affiliation(s)
- Feng-Ying Zhu
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Yu-Feng Sun
- College of Electronic Information Engineering, Hebei University, Baoding, 071002, China
| | - Xiao-Ping Yin
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Yu Zhang
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Li-Hong Xing
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Ze-Peng Ma
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Lin-Yan Xue
- College of Quality and Technical Supervision, Hebei University, No.180 of Wusi Road, Lianchi District, Baoding, 071002, China.
| | - Jia-Ning Wang
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China.
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Pierrard J, Seront E, Galot R, Gunes Tatar I, Baurain JF, Di Perri D. Regression of a melanoma brain metastasis that had appeared after immune checkpoint inhibitor discontinuation: a hypothesis-generating case. Acta Clin Belg 2023; 78:516-520. [PMID: 37466163 DOI: 10.1080/17843286.2023.2238374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/15/2023] [Indexed: 07/20/2023]
Abstract
We present the case of a 50-year-old woman previously treated with nivolumab-ipilimumab combination therapy for a metastatic melanoma. Despite premature discontinuation of these immune checkpoint inhibitors (ICIs) after 2 cycles due to severe immune-related hepatitis, the patient achieved a complete response. Nine months later, brain magnetic resonance imaging (MRI) showed progression of a single cerebral lesion, and the patient was referred for stereotactic radiosurgery. Unexpectedly, the brain MRI acquired one month later as part of radiosurgery planning showed a spontaneous regression of this lesion, allowing for radiosurgery cancellation. Follow-up imaging showed a sustained response, although the patient did not receive any other oncological treatment. We discuss here the potential immune mechanisms involved in this unusual course and the importance of better understanding the behaviour of tumours in the era of ICIs.
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Affiliation(s)
- Julien Pierrard
- UCLouvain, Institut de Recherche Experimentale Et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emmanuel Seront
- Medical Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Medical Oncology Department, Hopital de Jolimont, Haine Saint Paul, Belgium
| | - Rachel Galot
- UCLouvain, Institut de Recherche Experimentale Et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Medical Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Idil Gunes Tatar
- Radiology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-François Baurain
- UCLouvain, Institut de Recherche Experimentale Et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Medical Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dario Di Perri
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Zhang Y, Zhang H, Zhang H, Ouyang Y, Su R, Yang W, Huang B. Glioblastoma and Solitary Brain Metastasis: Differentiation by Integrating Demographic-MRI and Deep-Learning Radiomics Signatures. J Magn Reson Imaging 2023. [PMID: 37955154 DOI: 10.1002/jmri.29123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Studies have shown that deep-learning radiomics (DLR) could help differentiate glioblastoma (GBM) from solitary brain metastasis (SBM), but whether integrating demographic-MRI and DLR features can more accurately distinguish GBM from SBM remains uncertain. PURPOSE To construct and validate a demographic-MRI deep-learning radiomics nomogram (DDLRN) integrating demographic-MRI and DLR signatures to differentiate GBM from SBM preoperatively. STUDY TYPE Retrospective. POPULATION Two hundred and thirty-five patients with GBM (N = 115) or SBM (N = 120), randomly divided into a training cohort (90 GBM and 98 SBM) and a validation cohort (25 GBM and 22 SBM). FIELD STRENGTH/SEQUENCE Axial T2-weighted fast spin-echo sequence (T2WI), T2-weighted fluid-attenuated inversion recovery sequence (T2-FLAIR), and contrast-enhanced T1-weighted spin-echo sequence (CE-T1WI) using 1.5-T and 3.0-T scanners. ASSESSMENT The demographic-MRI signature was constructed with seven imaging features ("pool sign," "irregular ring sign," "regular ring sign," "intratumoral vessel sign," the ratio of the area of peritumoral edema to the enhanced tumor, the ratio of the lesion area on T2-FLAIR to CE-T1WI, and the tumor location) and demographic factors (age and sex). Based on multiparametric MRI, radiomics and deep-learning (DL) models, DLR signature, and DDLRN were developed and validated. STATISTICAL TESTS The Mann-Whitney U test, Pearson test, least absolute shrinkage and selection operator, and support vector machine algorithm were applied for feature selection and construction of radiomics and DL models. RESULTS DDLRN showed the best performance in differentiating GBM from SBM with area under the curves (AUCs) of 0.999 and 0.947 in the training and validation cohorts, respectively. Additionally, the DLR signature (AUC = 0.938) outperformed the radiomics and DL models, and the demographic-MRI signature (AUC = 0.775) was comparable to the T2-FLAIR radiomics and DL models in the validation cohort (AUC = 0.762 and 0.749, respectively). DATA CONCLUSION DDLRN integrating demographic-MRI and DLR signatures showed excellent performance in differentiating GBM from SBM. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yuze Zhang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongbo Zhang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hanwen Zhang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Ouyang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruru Su
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wanqun Yang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Biao Huang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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9
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Chew SH, Achmad Sankala HB, Chew E, Md Arif MHB, Mohd Zain NR, Hashim H, Koya Kutty SB, Chee YC, Mohd Saleh NB, Ong BH, Viswanathan S. Tumefactive demyelinating lesions versus CNS neoplasms, a comparative study. Mult Scler Relat Disord 2023; 79:104992. [PMID: 37717306 DOI: 10.1016/j.msard.2023.104992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Differentiating tumefactive demyelinating lesions (TDL) from neoplasms of the central nervous system continues to be a diagnostic dilemma in many cases. OBJECTIVE Our study aimed to examine and contrast the clinical and radiological characteristics of TDL, high-grade gliomas (HGG) and primary CNS lymphoma (CNSL). METHOD This was a retrospective review of 66 patients (23 TDL, 31 HGG and 12 CNSL). Clinical and laboratory data were obtained. MRI brain at presentation were analyzed by two independent, blinded neuroradiologists. RESULTS Patients with TDLs were younger and predominantly female. Sensorimotor deficits and ataxia were more common amongst TDL whereas headaches and altered mental status were associated with HGG and CNSL. Compared to HGG and CNSL, MRI characteristics supporting TDL included relatively smaller size, lack of or mild mass effect, incomplete peripheral rim enhancement, absence of central enhancement or restricted diffusion, lack of cortical involvement, and presence of remote white matter lesions on the index scan. Paradoxically, some TDLs may present atypically or radiologically mimic CNS lymphomas. CONCLUSION Careful evaluation of clinical and radiological features helps in differentiating TDLs at first presentation from CNS neoplasms.
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Affiliation(s)
- Sin Hong Chew
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
| | | | - Elaine Chew
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | | | | | - Hilwati Hashim
- Department of Radiology, Faculty of Medicine, Universiti Teknologi Mara, Malaysia
| | | | - Yong Chuan Chee
- Department of Medicine (Neurology), School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | | | - Beng Hooi Ong
- Neurology Unit, Kedah Medical Centre, Alor Setar, Malaysia
| | - Shanthi Viswanathan
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
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10
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Chaganti SS, Sidhom G, Chaganti J. Multiparametric imaging in the evaluation of intracerebral abscesses. Pract Neurol 2023; 23:376-385. [PMID: 37248041 DOI: 10.1136/pn-2023-003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
Cerebral abscesses are uncommon space occupying lesions; they are associated with high morbidity and mortality, though are potentially treatable. Patients often present with non-specific symptoms and may have few clinical signs. Routine clinical imaging may not give a definite diagnosis, as the findings can be indistinguishable from those of other intracranial mass lesions. We review the role of advanced MR techniques to characterise brain abscesses and discuss the role of imaging in monitoring their response to the treatment.
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Affiliation(s)
- Sai Sivananda Chaganti
- Fellow, Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - George Sidhom
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Joga Chaganti
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- Department of Radiology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
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11
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Solar P, Valekova H, Marcon P, Mikulka J, Barak M, Hendrych M, Stransky M, Siruckova K, Kostial M, Holikova K, Brychta J, Jancalek R. Classification of brain lesions using a machine learning approach with cross-sectional ADC value dynamics. Sci Rep 2023; 13:11459. [PMID: 37454179 PMCID: PMC10349862 DOI: 10.1038/s41598-023-38542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
Diffusion-weighted imaging (DWI) and its numerical expression via apparent diffusion coefficient (ADC) values are commonly utilized in non-invasive assessment of various brain pathologies. Although numerous studies have confirmed that ADC values could be pathognomic for various ring-enhancing lesions (RELs), their true potential is yet to be exploited in full. The article was designed to introduce an image analysis method allowing REL recognition independently of either absolute ADC values or specifically defined regions of interest within the evaluated image. For this purpose, the line of interest (LOI) was marked on each ADC map to cross all of the RELs' compartments. Using a machine learning approach, we analyzed the LOI between two representatives of the RELs, namely, brain abscess and glioblastoma (GBM). The diagnostic ability of the selected parameters as predictors for the machine learning algorithms was assessed using two models, the k-NN model and the SVM model with a Gaussian kernel. With the k-NN machine learning method, 80% of the abscesses and 100% of the GBM were classified correctly at high accuracy. Similar results were obtained via the SVM method. The proposed assessment of the LOI offers a new approach for evaluating ADC maps obtained from different RELs and contributing to the standardization of the ADC map assessment.
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Affiliation(s)
- Peter Solar
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Hana Valekova
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Marcon
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Jan Mikulka
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Martin Barak
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Hendrych
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- First Department of Pathology, St. Anne's University Hospital, Brno, Czech Republic
| | - Matyas Stransky
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Katerina Siruckova
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Martin Kostial
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Klara Holikova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Medical Imaging, St. Anne's University Hospital, Brno, Czech Republic
| | - Jindrich Brychta
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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12
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Duong MT, Rudie JD, Mohan S. Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications. Neuroimaging Clin N Am 2023; 33:11-41. [PMID: 36404039 PMCID: PMC10904173 DOI: 10.1016/j.nic.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neuroimaging provides rapid, noninvasive visualization of central nervous system infections for optimal diagnosis and management. Generalizable and characteristic imaging patterns help radiologists distinguish different types of intracranial infections including meningitis and cerebritis from a variety of bacterial, viral, fungal, and/or parasitic causes. Here, we describe key radiologic patterns of meningeal enhancement and diffusion restriction through profiles of meningitis, cerebritis, abscess, and ventriculitis. We discuss various imaging modalities and recent diagnostic advances such as deep learning through a survey of intracranial pathogens and their radiographic findings. Moreover, we explore critical complications and differential diagnoses of intracranial infections.
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Affiliation(s)
- Michael Tran Duong
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jeffrey D Rudie
- Department of Radiology, Scripps Clinic and University of California San Diego, 10666 Torrey Pines Road, La Jolla, CA 92037, USA
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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13
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French H, Fontes-Villalba A, Maharaj M, Naidoo CSY, Bhatia K, Paterson A, Cook R, Parratt J. Tumefactive multiple sclerosis versus high grade glioma: A diagnostic dilemma. Surg Neurol Int 2022; 13:146. [PMID: 35509579 PMCID: PMC9062904 DOI: 10.25259/sni_239_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/23/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Tumefactive demyelinating lesions (TDL) share similar clinical features and magnetic resonance imaging (MRI) characteristics with high grade glioma (HGG). This study develops an approach to navigating this diagnostic dilemma, with significant treatment implications as the management of both entities is drastically different.
Methods:
A retrospective analysis of 41 TDLs and 91 HGG with respect to demographics, presentation and classical MRI characteristics was performed. A diagnostic pathway was then developed to help diagnose TDLs based on whole neuraxis MRI and cerebrospinal fluid (CSF) examination.
Results:
The diagnosis of TDL is more likely than HGG in younger females who present with subacute or chronic symptoms. MRI characteristics favoring TDL over HGG include smaller size, open rim enhancement, little or no associated edema or mass effect and the presence of a T2 hypointense rim. MRI of the whole neuraxis for detection of other lesions typical of multiple sclerosis (MS), in combination with a lumbar puncture (LP) showing positive CSF-specific oligoclonal bands (OCB), was positive in 90% of the TDL cohort.
Conclusion:
The diagnostic pathway, proposed on the basis of specific clinicoradiological features, should be followed in patients with suspected TDL. If MRI demonstrates other lesions typical of MS and LP demonstrates positive CSF-specific OCBs, then patients should undergo a short course of IV steroids to look for clinical improvement. Patients, who continue to deteriorate, do not demonstrate other lesions on MRI or where the LP is negative for CSF-specific OCB, should be considered for biopsy if safe to do so. This pathway will give the patients the best chance at neurological preservation.
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Affiliation(s)
- Heath French
- Departments of Neurosurgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia,
| | | | - Monish Maharaj
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand,
| | | | - Kartik Bhatia
- Department of Radiology, Children’s Hospital, Westmead,
| | - Amanda Paterson
- Department of Neurosurgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Raymond Cook
- Departments of Neurosurgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia,
| | - John Parratt
- Neurology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia,
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14
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Machine Learning Applications for Differentiation of Glioma from Brain Metastasis-A Systematic Review. Cancers (Basel) 2022; 14:cancers14061369. [PMID: 35326526 PMCID: PMC8946855 DOI: 10.3390/cancers14061369] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary We present a systematic review of published reports on machine learning (ML) applications for the differentiation of gliomas from brain metastases by summarizing study characteristics, strengths, and pitfalls. Based on these findings, we present recommendations for future research in this field. Abstract Glioma and brain metastasis can be difficult to distinguish on conventional magnetic resonance imaging (MRI) due to the similarity of imaging features in specific clinical circumstances. Multiple studies have investigated the use of machine learning (ML) models for non-invasive differentiation of glioma from brain metastasis. Many of the studies report promising classification results, however, to date, none have been implemented into clinical practice. After a screening of 12,470 studies, we included 29 eligible studies in our systematic review. From each study, we aggregated data on model design, development, and best classifiers, as well as quality of reporting according to the TRIPOD statement. In a subset of eligible studies, we conducted a meta-analysis of the reported AUC. It was found that data predominantly originated from single-center institutions (n = 25/29) and only two studies performed external validation. The median TRIPOD adherence was 0.48, indicating insufficient quality of reporting among surveyed studies. Our findings illustrate that despite promising classification results, reliable model assessment is limited by poor reporting of study design and lack of algorithm validation and generalizability. Therefore, adherence to quality guidelines and validation on outside datasets is critical for the clinical translation of ML for the differentiation of glioma and brain metastasis.
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15
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Myeong H, Park M, Kim JE, Park SW, Lee SH. Delayed Cerebral Toxoplasmosis in a Kidney Transplant Patient: a Case Report. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:35-38. [PMID: 35247952 PMCID: PMC8898645 DOI: 10.3347/kjp.2022.60.1.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
Cerebral toxoplasmosis is often life-threatening in an immunocompromised patient due to delayed diagnosis and treatment. Several differential diagnoses could be possible only with preoperative brain images of cerebral toxoplasmosis which show multiple rim-enhancing lesions. Due to the rarity of cerebral toxoplasmosis cases in Korea, the diagnosis and treatment are often delayed. This paper concerns a male patient whose cerebral toxoplasmosis was activated 21 years post kidney transplantation. Brain open biopsy was decided to make an exact diagnosis. Cerebral toxoplasmosis was confirmed by immunohistochemistry and PCR analyses of the tissue samples. Although cerebral toxoplasmosis was under control with medication, the patient did not recover clinically and died due to sepsis and recurrent gastrointestinal bleeding.
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Affiliation(s)
- Hosung Myeong
- Department of Neurosurgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul 07061,
Korea
| | - Moowan Park
- Department of Neurosurgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul 07061,
Korea
| | - Ji Eun Kim
- Department of Pathology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061,
Korea
| | - Sun Won Park
- Department of Radiology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061,
Korea
| | - Sang Hyung Lee
- Department of Neurosurgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul 07061,
Korea
- Department of Neurosurgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061,
Korea
- Corresponding author ()
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16
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Wu J, Liang F, Wei R, Lai S, Lv X, Luo S, Wu Z, Chen H, Zhang W, Zeng X, Ye X, Wu Y, Wei X, Jiang X, Zhen X, Yang R. A Multiparametric MR-Based RadioFusionOmics Model with Robust Capabilities of Differentiating Glioblastoma Multiforme from Solitary Brain Metastasis. Cancers (Basel) 2021; 13:cancers13225793. [PMID: 34830943 PMCID: PMC8616314 DOI: 10.3390/cancers13225793] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/13/2021] [Accepted: 11/13/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Glioblastoma multiforme (GBM) and solitary brain metastasis (SBM) are common brain tumors in adults. The two tumors often pose a diagnostic dilemma owing to their similar features on conventional magnetic resonance imaging (MRI). Ability to discriminate the two tumors is critical as it informs clinical treatment strategies. This pilot study attempts to employ the machine learning technique to identify GBM and SBM by fusing radiomics features of multiple MRI sequences and multiple models. A multiparametric MR-based RadioFusionOmics (RFO) model was developed and has demonstrated promising prediction accuracy for the identifications of GBM and SBM. Abstract This study aimed to evaluate the diagnostic potential of a novel RFO model in differentiating GBM and SBM with multiparametric MR sequences collected from 244 (131 GBM and 113 SBM) patients. Three basic volume of interests (VOIs) were delineated on the conventional axial MR images (T1WI, T2WI, T2_FLAIR, and CE_T1WI), including volumetric non-enhanced tumor (nET), enhanced tumor (ET), and peritumoral edema (pTE). Using the RFO model, radiomics features extracted from different multiparametric MRI sequence(s) and VOI(s) were fused and the best sequence and VOI, or possible combinations, were determined. A multi-disciplinary team (MDT)-like fusion was performed to integrate predictions from the high-performing models for the final discrimination of GBM vs. SBM. Image features extracted from the volumetric ET (VOIET) had dominant predictive performances over features from other VOI combinations. Fusion of VOIET features from the T1WI and T2_FLAIR sequences via the RFO model achieved a discrimination accuracy of AUC = 0.925, accuracy = 0.855, sensitivity = 0.856, and specificity = 0.853, on the independent testing cohort 1, and AUC = 0.859, accuracy = 0.836, sensitivity = 0.708, and specificity = 0.919 on the independent testing cohort 2, which significantly outperformed three experienced radiologists (p = 0.03, 0.01, 0.02, and 0.01, and p = 0.02, 0.01, 0.45, and 0.02, respectively) and the MDT-decision result of three experienced experts (p = 0.03, 0.02, 0.03, and 0.02, and p = 0.03, 0.02, 0.44, and 0.03, respectively).
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Affiliation(s)
- Jialiang Wu
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
- Department of Radiology, The University of Hong Kong Shenzhen Hospital, Shenzhen 518000, China
| | - Fangrong Liang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China;
| | - Ruili Wei
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Shengsheng Lai
- School of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou 510520, China;
| | - Xiaofei Lv
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China;
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shiwei Luo
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Zhe Wu
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Huixian Chen
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Wanli Zhang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Xiangling Zeng
- Department of Radiology, Huizhou Municipal Central Hospital, Huizhou 516001, China;
| | - Xianghua Ye
- Department of Radiation Oncology, 1st Affiliated Hospital, Zhejiang University, Hangzhou 310009, China;
| | - Yong Wu
- Department of Oncology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China;
| | - Xinhua Wei
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Xinqing Jiang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Xin Zhen
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China;
- Correspondence: (X.Z.); (R.Y.); Tel.: +86-20-62789323 (X.Z.); +86-20-81048873 (R.Y.)
| | - Ruimeng Yang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
- Correspondence: (X.Z.); (R.Y.); Tel.: +86-20-62789323 (X.Z.); +86-20-81048873 (R.Y.)
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17
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Casper AC, Stenehjem EA, Gill DM, Evans JD. Streptococcus Intermedius: A Mimicker of Brain Metastases and A Potential Pitfall for Radiation Oncologists. Adv Radiat Oncol 2021; 6:100689. [PMID: 34409201 PMCID: PMC8361051 DOI: 10.1016/j.adro.2021.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anthony C Casper
- Department of Radiation Oncology, Intermountain Healthcare, Ogden, Utah.,Rocky Vista University College of Osteopathic Medicine, Ivins, Utah
| | - Edward A Stenehjem
- Department of Medicine, Division of Epidemiology and Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah
| | - David M Gill
- Department of Medical Oncology, Intermountain Healthcare, Salt Lake City, Utah
| | - Jaden D Evans
- Department of Radiation Oncology, Intermountain Healthcare, Ogden, Utah
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18
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Metz I, Gavrilova RH, Weigand SD, Frischer JM, Popescu BF, Guo Y, Gloth M, Tobin WO, Zalewski NL, Lassmann H, Tillema JM, Erickson BJ, Parisi JE, Becker S, König FB, Brück W, Lucchinetti CF. Magnetic Resonance Imaging Correlates of Multiple Sclerosis Immunopathological Patterns. Ann Neurol 2021; 90:440-454. [PMID: 34231919 DOI: 10.1002/ana.26163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Histology reveals that early active multiple sclerosis lesions can be classified into 3 main interindividually heterogeneous but intraindividually stable immunopathological patterns of active demyelination (patterns I-III). In patterns I and II, a T-cell- and macrophage-associated demyelination is suggested, with pattern II only showing signs of a humoral immune response. Pattern III is characterized by inflammatory lesions with an oligodendrocyte degeneration. Patterns suggest pathogenic heterogeneity, and we postulated that they have distinct magnetic resonance imaging (MRI) correlates that may serve as biomarkers. METHODS We evaluated in an international collaborative retrospective cohort study the MRI lesion characteristics of 789 conventional prebiopsy and follow-up MRIs in relation to their histopathologically classified immunopathological patterns (n = 161 subjects) and lesion edge features (n = 112). RESULTS A strong association of a ringlike enhancement and a hypointense T2-weighted (T2w) rim with patterns I and II, but not pattern III, was observed. Only a fraction of pattern III patients showed a ringlike enhancement, and this was always atypical. Ringlike enhancement and T2w rims colocalized, and ringlike enhancement showed a strong association with macrophage rims as shown by histology. A strong concordance of MRI lesion characteristics, meaning that different lesions showed the same features, was found when comparing biopsied and nonbiopsied lesions at a given time point, indicating lesion homogeneity within individual patients. INTERPRETATION We provide robust evidence that MRI characteristics reflect specific morphological features of multiple sclerosis immunopatterns and that ringlike enhancement and T2w hypointense rims might serve as a valuable noninvasive biomarker to differentiate pathological patterns of demyelination. ANN NEUROL 2021.
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Affiliation(s)
- Imke Metz
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Ralitza H Gavrilova
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | | | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Bogdan F Popescu
- Department of Anatomy, Physiology, and Pharmacology, and Cameco MS Neuroscience Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Mareike Gloth
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - William Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN.,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - Nicholas L Zalewski
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic, Scottsdale, AZ
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | | | | | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Stephanie Becker
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Fatima B König
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Institute of Pathology, Hospital Kassel, Kassel, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
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French HD. Tumefactive multiple sclerosis versus high-grade glioma: A diagnostic dilemma. Surg Neurol Int 2021; 12:199. [PMID: 34084626 PMCID: PMC8168700 DOI: 10.25259/sni_901_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Tumefactive demyelinating lesions (TDLs) share similar clinical features and MRI characteristics with high-grade glioma (HGG). This study develops an approach to navigating this diagnostic dilemma, with significant treatment implications as the management of both entities is drastically different. Methods: A retrospective analysis of 41 TDLs and 91 HGG with respect to demographics, presentation, and classical MRI characteristics was performed. A diagnostic pathway was then developed to help diagnose TDLs based on whole neuraxis MRI and cerebrospinal fluid (CSF) examination. Results: The diagnosis of TDL is more likely than HGG in younger females who present with subacute or chronic symptoms. MRI characteristics favoring TDL over HGG include smaller size, open rim enhancement, little or no associated edema or mass effect, and the presence of a T2 hypointense rim. MRI of the whole neuraxis for detection of other lesions typical of multiple sclerosis (MS), in combination with a lumbar puncture (LP) showing positive CSF-specific oligoclonal bands (OCB), was positive in 90% of the TDL cohort. Conclusion: The diagnostic pathway, proposed on the basis of specific clinicoradiological features, should be followed in patients with suspected TDL. If MRI demonstrates other lesions typical of MS and LP demonstrates positive CSF-specific OCBs, then patients should undergo a short course of IV steroids to look for clinical improvement. Patients who continue to deteriorate, do not demonstrate other lesions on MRI or where the LP is negative for CSF-specific OCB, should be considered for biopsy if safe to do so. This pathway will give the patients the best chance at neurological preservation.
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Affiliation(s)
- Heath David French
- Department of Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
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20
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Abstract
Nonneoplastic entities may closely resemble the imaging findings of primary or metastatic intracranial neoplasia, posing diagnostic challenges for the referring provider and radiologist. Prospective identification of brain tumor mimics is an opportunity for the radiologist to add value to patient care by decreasing time to diagnosis and avoiding unnecessary surgical procedures and medical therapies, but requires familiarity with mimic entities and a high degree of suspicion on the part of the interpreting radiologist. This article provides a framework for the radiologist to identify "brain tumor mimics," highlighting imaging and laboratory pearls and pitfalls, and illustrating unique and frequently encountered lesions.
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Affiliation(s)
- Joseph H Donahue
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA
| | - Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA
| | - Camilo E Fadul
- Department of Neurology, University of Virginia Health System, PO Box 800432, Charlottesville, VA 22908-0170, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA.
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21
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Xie N, Sun Q, Yang J, Zhou Y, Xu H, Zhou L, Zhou Y. High clinical heterogeneity in a Chinese pedigree of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S). Orphanet J Rare Dis 2021; 16:56. [PMID: 33516249 PMCID: PMC7847589 DOI: 10.1186/s13023-021-01712-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Being a newly defined disease, RVCL-S is underrecognized by clinicians globally. It is an autosomal dominantly inherited small vessel disease caused by the heterozygous C-terminal frameshift mutation in TREX1 gene. RVCL-S is featured by cerebral dysfunction, retinopathy, and vasculopathy in multiple internal organs. Misdiagnosis may cause devastating consequences in patients, such as iatrogenic PML caused by misuse of immunosuppressants. Thus, increasing awareness of this disease is in urgent need. Results We uncovered a large Chinese origin RVCL-S pedigree bearing the TREX1 mutation. A comprehensive characterization combining clinical, genetic, and neuropathological analysis was performed. The Intrafamilial comparison showed highly heterogeneous clinical phenotypes. Mutation carriers in our pedigree presented with retinopathy (8/13), seizures (2/13), increased intracranial pressure (1/13), mild cognitive impairment (3/13), stroke-like episode (3/13), mesenteric ischemia (1/13), nephropathy (9/13), ascites (3/13), hypertension (9/13), hyperlipidemia (3/8), hypoalbuminemia (3/8), normocytic anemia (3/8), subclinical hypothyroidism (1/8), hyperfibrinogenemia (1/8), hyperparathyroidism (2/8), and abnormal inflammatory markers (4/8). The constellation of symptoms is highly varied, making RVCL-S a challenging diagnosis. Comparison with reported RVCL-S pedigrees further revealed that the mesenteric ischemia is a novel clinical finding and the MRS pattern of brain lesions is emulating neoplasm and tumefactive demyelination. Conclusion Our reports characterize a highly heterogeneous RVCL-S pedigree, highlight the probability of misdiagnosis in clinical practice, and broaden the clinical spectrum of RVCL-S.
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Affiliation(s)
- Nina Xie
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Qiying Sun
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Jinxia Yang
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yangjie Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hongwei Xu
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Lin Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Yafang Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China.
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22
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Zidan MA, Hassan RS, El-Noueam KI, Zakaria YM. Brain metastases assessment by FDG-PET/CT: can it eliminate the necessity for dedicated brain imaging? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Brain metastases (BM) are the most common intracranial tumors in adults outnumbering all other intracranial neoplasms. Positron emission tomography combined with computed tomography (PET/CT) is a widely used imaging modality in oncology with a unique combination of cross-sectional anatomic information provided by CT and the metabolic information provided by PET using the [18F]-2-fluoro-2-deoxy-d-glucose (FDG) as a tracer. The aim of the study is to assess the role and diagnostic performance of brain-included whole-body PET/CT in detection and evaluation of BM and when further imaging is considered necessary. The study was conducted over a period of 12 months on 420 patients suffering from extra-cranial malignancies utilizing brain-included whole-body PET/CT.
Results
Thirty patients with 71 brain lesions were detected, 18 patients (60%) had BM of unknown origin while 12 patients (40%) presented with known primary tumors. After brain-included whole-body FDG-PET/CT examination, the unknown primaries turned out to be bronchogenic carcinoma in 10 patients (33.3%), renal cell carcinoma in 2 patients (6.7%), and lymphoma in 2 patients (6.7%), yet the primary tumors remained unknown in 4 patients (13.3%). In 61 lesions (85.9%), the max SUV ranged from 0.2- < 10, while in 10 lesions (14.1%) the max SUV ranged from 10 to 20. Hypometabolic lesions were reported in 41 (57.7%) lesions, hypermetabolic in 3 lesions (4.2%), whereas 27 lesions (38.0%) showed similar FDG uptake to the corresponding contralateral brain matter. PET/CT overall sensitivity, specificity, positive and negative predictive, and accuracy values were 78.1, 92.6, 83.3, 90, and 88% respectively.
Conclusion
Brain-included whole-body FDG-PET/CT provides valuable complementary information in the evaluation of patients with suspected BM. However, the diagnostic performance of brain PET-CT carries the possibility of false-negative results with consequent false sense of security. The clinicians should learn about the possible pitfalls of PET/CT interpretation to direct patients with persistent neurological symptoms or high suspicion for BM for further dedicated CNS imaging.
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23
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AlTokhis AI, AlOtaibi AM, Felmban GA, Constantinescu CS, Evangelou N. Iron Rims as an Imaging Biomarker in MS: A Systematic Mapping Review. Diagnostics (Basel) 2020; 10:diagnostics10110968. [PMID: 33218056 PMCID: PMC7698946 DOI: 10.3390/diagnostics10110968] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/27/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Multiple sclerosis (MS) is an autoimmune, inflammatory, demyelinating and degenerative disease of the central nervous system (CNS). To date, there is no definitive imaging biomarker for diagnosing MS. The current diagnostic criteria are mainly based on clinical relapses supported by the presence of white matter lesions (WMLs) on MRI. However, misdiagnosis of MS is still a significant clinical problem. The paramagnetic, iron rims (IRs) around white matter lesions have been proposed to be an imaging biomarker in MS. This study aimed to carry out a systematic mapping review to explore the detection of iron rim lesions (IRLs), on clinical MR scans, and describe the characteristics of IRLs presence in MS versus other MS-mimic disorders. Methods: Publications from 2001 on IRs lesions were reviewed in three databases: PubMed, Web of Science and Embase. From the initial result set 718 publications, a final total of 38 papers were selected. Results: The study revealed an increasing interest in iron/paramagnetic rims lesions studies. IRs were more frequently found in periventricular regions and appear to be absent in MS-mimics. Conclusions IR is proposed as a promising imaging biomarker for MS.
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Affiliation(s)
- Amjad I. AlTokhis
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
- School of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- Correspondence:
| | - Abdulmajeed M. AlOtaibi
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
- School of Applied Medical Sciences, King Saud bin Abdulaziz University, Riyadh 14611, Saudi Arabia
| | - Ghadah A. Felmban
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
- School of Applied Medical Sciences, King Saud bin Abdulaziz University, Riyadh 14611, Saudi Arabia
| | - Cris S. Constantinescu
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
| | - Nikos Evangelou
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
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24
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Alves AFF, Miranda JRDA, Reis F, de Souza SAS, Alves LLR, Feitoza LDM, de Castro JTDS, de Pina DR. Inflammatory lesions and brain tumors: is it possible to differentiate them based on texture features in magnetic resonance imaging? J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200011. [PMID: 32952531 PMCID: PMC7473508 DOI: 10.1590/1678-9199-jvatitd-2020-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Neuroimaging strategies are essential to locate, to elucidate the etiology, and to the follow up of brain disease patients. Magnetic resonance imaging (MRI) provides good cerebral soft-tissue contrast detection and diagnostic sensitivity. Inflammatory lesions and tumors are common brain diseases that may present a similar pattern of a cerebral ring enhancing lesion on MRI, and non-enhancing core (which may reflect cystic components or necrosis) leading to misdiagnosis. Texture analysis (TA) and machine learning approaches are computer-aided diagnostic tools that can be used to assist radiologists in such decisions. Methods: In this study, we combined texture features with machine learning (ML) methods aiming to differentiate brain tumors from inflammatory lesions in magnetic resonance imaging. Retrospective examination of 67 patients, with a pattern of a cerebral ring enhancing lesion, 30 with inflammatory, and 37 with tumoral lesions were selected. Three different MRI sequences and textural features were extracted using gray level co-occurrence matrix and gray level run length. All diagnoses were confirmed by histopathology, laboratorial analysis or MRI. Results: The features extracted were processed for the application of ML methods that performed the classification. T1-weighted images proved to be the best sequence for classification, in which the differentiation between inflammatory and tumoral lesions presented high accuracy (0.827), area under ROC curve (0.906), precision (0.837), and recall (0.912). Conclusion: The algorithm obtained textures capable of differentiating brain tumors from inflammatory lesions, on T1-weghted images without contrast medium using the Random Forest machine learning classifier.
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Affiliation(s)
- Allan Felipe Fattori Alves
- Department of Physics and Biophysics, Botucatu Biosciences Institute, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - José Ricardo de Arruda Miranda
- Department of Physics and Biophysics, Botucatu Biosciences Institute, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Fabiano Reis
- Department of Radiology, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Sergio Augusto Santana de Souza
- Department of Physics and Biophysics, Botucatu Biosciences Institute, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Luciana Luchesi Rodrigues Alves
- Department of Physics and Biophysics, Botucatu Biosciences Institute, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Laisson de Moura Feitoza
- Department of Radiology, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | | | - Diana Rodrigues de Pina
- Department of Tropical Disease and Imaging Diagnosis, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
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25
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Braileanu M, Wicks JM, Saindane AM. Appearance of an unusual ring enhancing brain capillary telangiectasia on 3.0T MRI with dynamic susceptibility contrast perfusion. Radiol Case Rep 2020; 15:1331-1334. [PMID: 32612734 PMCID: PMC7322129 DOI: 10.1016/j.radcr.2020.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/03/2022] Open
Abstract
We present the appearance of brain capillary telangiectasia on 3.0T magnetic resonance imaging (MRI) perfusion. A 42-year-old female presented with intermittent left arm weakness and paresthesia. Initial 1.5T MRI obtained 2 months after presentation demonstrated a 6 mm right caudate head lesion with ring-like enhancement, and no significant surrounding edema or mass effect. On gradient echo there was mild associated susceptibility artifact. Follow-up 3.0T MRI demonstrated increased blooming on 3.0T imaging relative to prior 1.5T imaging. The lesion also demonstrated increased blood volume on dynamic susceptibility contrast perfusion. Given these imaging findings and interval stability, a definitive imaging diagnosis of capillary telangiectasia was made. Recognition of the MRI findings of capillary telangiectasia is imperative to avoid misdiagnosis and prevent unnecessary intervention.
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Affiliation(s)
- Maria Braileanu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, Suite BG23, Atlanta, GA 30322, USA
| | - Jaime M Wicks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, Suite BG23, Atlanta, GA 30322, USA
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, Suite BG23, Atlanta, GA 30322, USA
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Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e28-e34. [DOI: 10.15586/jptcp.v27i3.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
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27
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Lee HW, Cho J, Kwak N, Hwang I, Park YS, Lee CH, Lee SM, Yoo CG, Kim YW, Choi SM. Clinical course of asymptomatic small enhancing brain nodules in patients with nonsmall cell lung cancer: do we have to follow them up? ERJ Open Res 2020; 6:00109-2020. [PMID: 32964000 PMCID: PMC7487354 DOI: 10.1183/23120541.00109-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Brain magnetic resonance imaging (MRI) is recommended during the initial work-up for nonsmall cell lung cancer (NSCLC). Although small enhancing brain nodules not radiologically confirmed as metastatic lesions have often been detected, their clinical course has not been well studied. METHODS This nested case-control study included NSCLC patients who had small enhancing brain nodules detected by serial brain MRIs from January 2014 through December 2018 at a tertiary university hospital. Small enhancing brain nodules were defined as round enhancing nodules of ≤10 mm diameter without oedema in thin-section (1 mm) contrast MRIs. The incidence, natural course and risk factors of growing nodules were evaluated. RESULTS A total of 171 small enhancing brain nodules in 123 patients were observed over an average of 22.1 months. The incidence of nodule growth was 49.1% with mean growth rate of 11 mm·year-1. We found that 25.0% of the growing nodules contributed to clinical upstaging compared to the initial stage. Cerebral events were more common in growing nodules; therefore, local therapy was performed more often. However, there was no difference in the cerebral event-related mortality. Nodule growth was more frequent in younger individuals, multiple nodules, advanced disease, poorly differentiated carcinoma, rim enhancement and larger initial size. In multivariable analysis, predictors of growth were N stage ≥1, existence of epidermal growth factor receptor mutation and larger initial size. CONCLUSION Considering the clinical course of small enhancing brain nodules, more intensive evaluation is required for early detection and pre-emptive intervention when accompanied by risk factors.
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Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Inpyeong Hwang
- Dept of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Ichikawa T, Shimojima Y, Kishida D, Kaneko T, Sekijima Y. Primary central nervous system lymphoma in neuropsychiatric systemic lupus erythematosus: case-based review. Rheumatol Int 2020; 41:1009-1017. [PMID: 32253501 DOI: 10.1007/s00296-020-04569-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) sometimes occurs in immune-compromised hosts or patients with autoimmune diseases. Some cohort studies have previously reported an increased risk of non-Hodgkin's lymphoma in systemic lupus erythematosus (SLE), while some cases of PCNSL in patients with SLE were reported. We present the case of PCNSL which developed in a patient with the active phase of neuropsychiatric SLE (NPSLE). Furthermore, we reviewed published English articles to confirm the characteristics of PCNSL related to SLE. To our knowledge, this is the first report of PCNSL occurring in NPSLE. Histology demonstrated B-cell lymphoma with a positive Epstein-Barr virus-encoded RNA. This patient recovered following surgical resection of the lymphoma, whole brain radiation therapy, intravenous infusion of rituximab (RTX), and administration of belimumab after RTX. Given the series of reviews, our report suggests that the persistence of damage in the central nervous system (CNS) and long-term exposure to immunosuppressants may impact oncogenic immune responses within the CNS, leading to PCNSL development.
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MESH Headings
- Adult
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Agents, Immunological/administration & dosage
- Brain/diagnostic imaging
- Brain/pathology
- Female
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunosuppression Therapy/adverse effects
- Immunosuppressive Agents/administration & dosage
- Lupus Vasculitis, Central Nervous System/complications
- Lupus Vasculitis, Central Nervous System/drug therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Rituximab/administration & dosage
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Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tomoki Kaneko
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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29
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Fujio S, Takajo T, Kinoshita Y, Hanaya R, Arimura H, Sugata J, Sugata S, Bohara M, Hiraki T, Yoshimoto K, Arita K. Sellar Xanthogranuloma: A Quest Based on Nine Cases Assessed with an Anterior Pituitary Provocation Test. World Neurosurg 2019; 130:e150-e159. [DOI: 10.1016/j.wneu.2019.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
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30
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Kolakshyapati M, Hashizume A, Ochi K, Ueno H, Kaichi Y, Takayasu T, Takano M, Karlowee V, Akiyama Y, Awai K, Maruyama H, Sugiyama K, Kurisu K, Yamasaki F. Usefulness of Histogram-Profile Analysis in Ring-Enhancing Intracranial Lesions. World Neurosurg 2019; 131:e226-e236. [PMID: 31349079 DOI: 10.1016/j.wneu.2019.07.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several intracranial pathologies present as a ring-enhancing lesion on conventional magnetic resonance imaging (MRI), creating diagnostic difficulty. We studied the characteristics of the anatomical border of gadolinium enhancement on T1-weighted imaging (WI) and hypointensity on T2WI to employ a simple technique of histogram-profile analysis of MRI for differentiation of various ring-enhancing intracranial lesions. METHODS After approval from the institutional review board, preoperative MRI (T2WI, postcontrast T1WI) scans were analyzed retrospectively in 18 patients with histologically confirmed brain abscess, 66 glioblastomas, 46 brain-metastases, and 16 tumefactive multiple sclerosis (MS). T2WI and postcontrast T1WI were overlapped, and histogram-profile analysis was performed with in-house image-fusion software. The pattern of differential-peaks in histogram-profile was assessed visually. Kaplan-Meier survival analysis incorporating histogram-profile patterns was performed in patients with glioblastoma. RESULTS The histogram-profile study revealed 4 distinct patterns. Pattern 1 showed no differential T2-hypointensity trough, pattern 2 had T2-hypointensity trough inside, whereas pattern 3 had T2-hypointensity trough overlapping the enhanced margin. Pattern 4 had T2-hypointensity trough immediately external to the enhanced margin. Pattern 1 was specific for tumefactive MS (93.3%), whereas pattern 4 was specific for glioblastoma (40.7%). Pattern 4 glioblastoma was subdivided into rim (T2-hypointensity ≥50% of circumference of contrast-enhanced tumor) and arc (T2-hypointensity <50% of circumference of contrast-enhanced tumor). Pattern 4 glioblastoma was further subdivided into group A (edema: T2-hyperintensity ≥50% of circumference of contrast-enhanced tumor) and group B (less edema: T2-hyperintensity <50% of circumference of contrast-enhanced tumor). Patients with pattern 3 glioblastoma (37.6%) had better survival compared with others (P = 0.0341) and pattern 4B had decreased survival compared with pattern 4A (P = 0.0001) and others (P = 0.0003). CONCLUSIONS Tumefactive MS and a subset of glioblastomas show specific patterns in histogram-profile analysis. The difference in anatomical border also determines difference in survival in glioblastoma. Histogram-profile analysis is a simple and efficient technique to differentiate these pathologies.
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Affiliation(s)
- Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akira Hashizume
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhide Ochi
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ueno
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoko Kaichi
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Vega Karlowee
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Akiyama
- Department of Clinical Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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White MD, Agarwal N, Tonetti DA. The Utility of Whole Body Imaging in the Evaluation of Solitary Brain Tumors. World Neurosurg 2019; 126:e1206-e1210. [PMID: 30885857 DOI: 10.1016/j.wneu.2019.02.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Solitary brain tumors can propose a diagnostic dilemma owing to the difficulty in differentiating between primary brain tumors and metastatic disease. The similar radiologic appearance on routine magnetic resonance imaging will necessitate the need for additional noninvasive testing. We sought to determine the clinical utility of preoperative whole body screening with computed tomography (CT) to detect metastatic disease in patients with solitary brain tumors. METHODS A prospectively maintained surgical database for a large quaternary care academic institution was retrospectively reviewed for all patients undergoing craniotomy for a new diagnosis of enhancing solitary brain lesion from January 2011 to January 2016. Patients were excluded if the imaging findings had demonstrated multiple brain tumors, they had a known diagnosis of malignancy, or they had undergone previous craniotomy. The demographic and radiographic information and clinical and histopathologic data were collected and tallied. RESULTS A total of 218 patients with solitary brain tumors met the inclusion criteria and were included in the present study. Histopathologic analysis confirmed primary central nervous system tumors in 152 patients (74.4%) and metastatic disease in 66 (25.6%). Preoperative screening with whole body CT had a sensitivity of 0.92 and specificity of 0.95 for detecting systemic metastases in the patients. Preoperative whole body CT correctly identified systemic malignancy in 88% of the patients ultimately diagnosed with metastasis (positive predictive value, 88%). Of those with negative whole body imaging findings, 97% had a diagnosis of a primary central nervous system neoplasm (negative predictive value, 97%). CONCLUSIONS Preoperative whole body CT had a positive predictive value of 88% and negative predictive value of 97% in the present study and was both sensitive (92%) and specific (95%) for the detection of extracranial tumors. The identification of extracranial tumors on whole body CT screening might alter management.
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Affiliation(s)
- Michael D White
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Durmo F, Rydelius A, Cuellar Baena S, Askaner K, Lätt J, Bengzon J, Englund E, Chenevert TL, Björkman-Burtscher IM, Sundgren PC. Multivoxel 1H-MR Spectroscopy Biometrics for Preoprerative Differentiation Between Brain Tumors. ACTA ACUST UNITED AC 2018; 4:172-181. [PMID: 30588503 PMCID: PMC6299741 DOI: 10.18383/j.tom.2018.00051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We investigated multivoxel proton magnetic resonance spectroscopy (1H-MRS) biometrics for preoperative differentiation and prognosis of patients with brain metastases (MET), low-grade glioma (LGG) and high-grade glioma (HGG). In total, 33 patients (HGG, 14; LGG, 9; and 10 MET) were included. 1H-MRS imaging (MRSI) data were assessed and neurochemical profiles for metabolites N-acetyl aspartate (NAA) + NAAG(NAA), Cr + PCr(total creatine, tCr), Glu + Gln(Glx), lactate (Lac), myo-inositol(Ins), GPC + PCho(total choline, tCho), and total lipids, and macromolecule (tMM) signals were estimated. Metabolites were reported as absolute concentrations or ratios to tCho or tCr levels. Voxels of interest in an MRSI matrix were labeled according to tissue. Logistic regression, receiver operating characteristic, and Kaplan-Meier survival analysis was performed. Across HGG, LGG, and MET, average Ins/tCho was shown to be prognostic for overall survival (OS): low values (≤1.29) in affected hemisphere predicting worse OS than high values (>1.29), (log rank < 0.007). Lip/tCho and Ins/tCho combined showed 100% sensitivity and specificity for both HGG/LGG (P < .001) and LGG/MET (P < .001) measured in nonenhancing/contrast-enhancing lesional tissue. Combining tCr/tCho in perilesional edema with tCho/tCr and NAA/tCho from ipsilateral normal- appearing tissue yielded 100% sensitivity and 81.8% specificity (P < .002) for HGG/MET. Best single biomarker: Ins/tCho for HGG/LGG and total lipid/tCho for LGG/MET showed 100% sensitivity and 75% and 100% specificity, respectively. HGG/MET; NAA/tCho showed 75% sensitivity and 84.6% specificity. Multivoxel 1H-MRSI provides prognostic information for OS for HGG/LGG/MET and a multibiometric approach for differentiation may equal or outperform single biometrics.
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Affiliation(s)
- Faris Durmo
- Departments of Clinical Sciences/Division of Radiology
| | - Anna Rydelius
- Clinical Sciences/Division of Neurology, Lund University, Lund, Sweden
| | | | | | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund and Malmö, Sweden
| | - Johan Bengzon
- Departments of Clinical Sciences/Division of Neurosurgery
| | - Elisabet Englund
- Clinical Sciences/Division of Oncology and Pathology, Lund University, Lund, Sweden
| | | | - Isabella M Björkman-Burtscher
- Departments of Clinical Sciences/Division of Radiology.,Center for Medical Imaging and Physiology, Skåne University Hospital, Lund and Malmö, Sweden
| | - Pia C Sundgren
- Departments of Clinical Sciences/Division of Radiology.,Center for Medical Imaging and Physiology, Skåne University Hospital, Lund and Malmö, Sweden.,Department of Radiology, University of Michigan, Ann Arbor, MI; and.,LBIC, Lund University Bioimaging Center, Lund University, Lund, Sweden
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Mahammedi A, Bachir S, Purdy J, Larvie M, Buehler M. Pyogenic brain abscess, ventriculitis and diffuse meningitis with fatal outcome in an adult: Radiologic-pathologic correlation ☆,. Radiol Case Rep 2018; 13:1063-1068. [PMID: 30228844 PMCID: PMC6137902 DOI: 10.1016/j.radcr.2018.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 10/25/2022] Open
Abstract
Rupture of brain abscesses with evolution into ventriculitis with meningitis may result in sudden and dramatic worsening of the clinical situation. We present a 57-year-old man with such an event and fatal outcome. Multiple imaging modalities including computed tomography and advanced magnetic resonance imaging were correlated with gross specimen and histologic images. The differential diagnosis of multiple lesions with ring enhancement and prominent perifocal edema includes mainly infectious and neoplastic processes, such as brain abscess, metastasis, and multicentric glioblastoma. Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We discuss the characteristic magnetic resonance findings of brain abscess and its complications, including meningitis and ventriculitis with emphasis on the role of diffusion-weighted and fluid-attenuated inversion recovery imaging.
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Affiliation(s)
- Abdelkader Mahammedi
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Suha Bachir
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Jenna Purdy
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
| | - Mykol Larvie
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Mark Buehler
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
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Balloy G, Pelletier J, Suchet L, Lebrun C, Cohen M, Vermersch P, Zephir H, Duhin E, Gout O, Deschamps R, Le Page E, Edan G, Labauge P, Carra-Dallieres C, Rumbach L, Berger E, Lejeune P, Devos P, N'Kendjuo JB, Coustans M, Auffray-Calvier E, Daumas-Duport B, Michel L, Lefrere F, Laplaud DA, Brosset C, Derkinderen P, de Seze J, Wiertlewski S. Inaugural tumor-like multiple sclerosis: clinical presentation and medium-term outcome in 87 patients. J Neurol 2018; 265:2251-2259. [PMID: 30054790 DOI: 10.1007/s00415-018-8984-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tumefactive demyelinating lesions of the central nervous system can be the initial presentation in various pathological entities [multiple sclerosis (the most common), Balo's concentric sclerosis, Schilder's disease and acute disseminated encephalomyelitis] with overlapping clinical presentation. The aim of our study was to better characterize these patients. METHODS Eighty-seven patients (62 women and 25 men) from different MS centers in France were studied retrospectively. Inclusion criteria were (1) a first clinical event (2) MRI showing one or more large demyelinating lesions (20 mm or more in diameter) with mass-like features. Patients with a previous demyelinating event (i.e. confirmed multiple sclerosis) were excluded. RESULTS Mean age at onset was 26 years. The most common initial symptoms (67% of the patients) were hemiparesis or hemiplegia. Aphasia, headache and cognitive disturbances (i.e. atypical symptoms for demyelinating diseases) were observed in 15, 18 and 15% of patients, respectively. The mean largest diameter of the tumefactive lesions was 26.9 mm, with gadolinium enhancement in 66 patients (81%). Twenty-one patients (24%) had a single tumefactive lesion. During follow-up (median time 5.7 years) 4 patients died, 70 patients improved or remained stable and 12 worsened. 86% of patients received initial corticosteroid treatment, and 73% received disease-modifying therapy subsequently. EDSS at the end of the follow-up was 2.4 ± 2.6 (mean ± SD). CONCLUSION This study provides further evidence that the clinical course of MS presenting with large focal tumor-like lesions does not differ from that of classical relapsing-remitting MS, once the noisy first relapsing occurred.
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Affiliation(s)
- G Balloy
- Neurology Department, University of Nantes Hospital, Nantes, France. .,Service de Neurologie, Hopital Laennec, Boulevard Jacques Monod, 44800, Saint Herblain, France.
| | - J Pelletier
- Neurosciences Unit, Neurology Department, Timone Hospital, Aix Marseille University, APHM, Marseille, France
| | - L Suchet
- Neurosciences Unit, Neurology Department, Timone Hospital, Aix Marseille University, APHM, Marseille, France
| | - C Lebrun
- University of Nice Hospital, Nice, France
| | - M Cohen
- University of Nice Hospital, Nice, France
| | | | - H Zephir
- University of Lille Hospital, Lille, France
| | - E Duhin
- University of Lille Hospital, Lille, France
| | - O Gout
- Rothschild Foundation, Paris, France
| | | | - E Le Page
- University of Rennes Hospital, Rennes, France
| | - G Edan
- University of Rennes Hospital, Rennes, France
| | - P Labauge
- University of Montpellier Hospital, Montpellier, France
| | | | - L Rumbach
- University Besançon Hospital, Besançon, France
| | - E Berger
- University Besançon Hospital, Besançon, France
| | - P Lejeune
- La Roche sur Yon Hospital, La Roche-sur-Yon, France
| | - P Devos
- Boulogne-sur-Mer Hospital, Boulogne-sur-Mer, France
| | | | | | | | - B Daumas-Duport
- Radiology Department, University of Nantes Hospital, Nantes, France
| | - L Michel
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - F Lefrere
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - D A Laplaud
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - C Brosset
- Military Hospital, Marseille, France
| | - P Derkinderen
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - J de Seze
- University of Strasbourg Hospital, Strasbourg, France
| | - S Wiertlewski
- Neurology Department, University of Nantes Hospital, Nantes, France
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Nakashima K, Uematsu T, Sugino T, Takahashi K, Nishimura S, Tadokoro Y, Hayashi T. T2-hypointense rim of breast mass lesions on magnetic resonance images: Radiologic-pathologic correlation. Breast J 2018; 24:944-950. [PMID: 29785726 DOI: 10.1111/tbj.13068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
We investigated the radiologic-pathologic correlation of a strong hypointense rim on T2-weighted images (T2-hypo-rim) surrounding breast mass lesions and evaluated its clinical significance. We retrospectively reviewed 3503 consecutive breast magnetic resonance imaging (MRI) examinations. The T2-hypo-rim was defined as a border of strong hypointensity compared with the fat signal on fat-suppressed T2-weighted images. Detected lesions with T2-hypo-rim were classified as a solid or cystic mass with MRI and correlated with histopathologic findings. Sixty-two masses (2%; 34 solid, 28 cystic) with T2-hypo-rim were detected [44 breast cancers, 18 benign lesions, including 15 (24%) papillary tumors]. Patients with cancer were significantly older than those with benign lesions (P = .002). Breast cancers were significantly larger than benign masses (P = .023). In 49 of 62 lesions (24 solid and 16 cystic cancers; three solid and six cystic benign masses), the rims were accurately correlated with the histopathologic findings. All malignant and benign cystic masses exhibited hemosiderin deposits in the cyst walls. However, 22 of 24 solid cancers and no solid benign masses exhibited hemosiderin at the tumor periphery (92% and 0%, respectively, P < .001). In addition, a thick fibrous capsule was present in nine (38%) of 24 solid cancers and none of the solid benign lesions. Strong T2-hypo-rims mostly correlated with hemosiderin deposits and/or sometimes fibrous capsules. Although the rims could not distinguish malignant from benign cystic lesions, they indicated malignancy in solid mass lesions on MRI. Additionally, the rims often indicated papillary tumors.
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Affiliation(s)
- Kazuaki Nakashima
- Department of Breast Imaging and Intervention, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takayoshi Uematsu
- Department of Breast Imaging and Intervention, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takashi Sugino
- Department of Pathology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Kaoru Takahashi
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | | | - Yukiko Tadokoro
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tomomi Hayashi
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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Differentiation of brain infection from necrotic glioblastoma using combined analysis of diffusion and perfusion MRI. J Magn Reson Imaging 2018; 49:184-194. [DOI: 10.1002/jmri.26053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/28/2018] [Indexed: 12/13/2022] Open
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Lin L, Xue Y, Duan Q, Sun B, Lin H, Huang X, Chen X. The role of cerebral blood flow gradient in peritumoral edema for differentiation of glioblastomas from solitary metastatic lesions. Oncotarget 2018; 7:69051-69059. [PMID: 27655705 PMCID: PMC5356611 DOI: 10.18632/oncotarget.12053] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/02/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Differentiation of glioblastomas from solitary brain metastases using conventional MRI remains an important unsolved problem. In this study, we introduced the conception of the cerebral blood flow (CBF) gradient in peritumoral edema-the difference in CBF values from the proximity of the enhancing tumor to the normal-appearing white matter, and investigated the contribution of perfusion metrics on the discrimination of glioblastoma from a metastatic lesion. MATERIALS AND METHODS Fifty-two consecutive patients with glioblastoma or a solitary metastatic lesion underwent three-dimensional arterial spin labeling (3D-ASL) before surgical resection. The CBF values were measured in the peritumoral edema (near: G1; Intermediate: G2; Far: G3). The CBF gradient was calculated as the subtractions CBFG1 -CBFG3, CBFG1 - CBFG2 and CBFG2 - CBFG3. A receiver operating characteristic (ROC) curve analysis was used to seek for the best cutoff value permitting discrimination between these two tumors. RESULTS The absolute/related CBF values and the CBF gradient in the peritumoral regions of glioblastomas were significantly higher than those in metastases(P < 0.038). ROC curve analysis reveals, a cutoff value of 1.92 ml/100g for the CBF gradient of CBFG1 -CBFG3 generated the best combination of sensitivity (92.86%) and specificity (100.00%) for distinguishing between a glioblastoma and metastasis. CONCLUSION The CBF gradient in peritumoral edema appears to be a more promising ASL perfusion metrics in differentiating high grade glioma from a solitary metastasis.
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Affiliation(s)
- Lin Lin
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yunjing Xue
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Qing Duan
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Bin Sun
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Hailong Lin
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xinming Huang
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaodan Chen
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
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Wehrum T, Beume LA, Stich O, Mader I, Mäurer M, Czaplinski A, Weiller C, Rauer S. Activation of disease during therapy with alemtuzumab in 3 patients with multiple sclerosis. Neurology 2018; 90:e601-e605. [PMID: 29352101 DOI: 10.1212/wnl.0000000000004950] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 10/18/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report 3 patients with multiple sclerosis showing severe activation of disease during immunotherapy with alemtuzumab. METHODS Retrospective case series. RESULTS Patient 1, a 21-year-old woman, developed severe cognitive impairment, sight deterioration, severe gait ataxia, urinary retention, and extensive progression of cerebral lesion load, including new lesions that exhibited gadolinium ring enhancement and dominance of CD19/20-positive B lymphocytes, 6 months after induction of alemtuzumab. Patient 2, a 28-year-old man, developed left-sided hemihypesthesia and ∼60 new cerebral and spinal lesions including lesions with gadolinium ring enhancement 6 months after induction of alemtuzumab. Patient 3, a 37-year-old woman, developed ataxia and numbness of the left thigh, 16 new gadolinium-positive supratentorial lesions, and partly ring-enhancing and dominance of CD19/20-positive B lymphocytes 6 months after induction of alemtuzumab. CONCLUSION This is a case series reporting severe activation of disease during immunotherapy with alemtuzumab. All patients showed onset of symptoms 6 months after induction of alemtuzumab, strikingly similar MRI lesion morphology, and unexpected high total B cell count, which may suggest a B-cell-mediated activation of disease. Whether this is due to different rates of B- and T cell repopulation has to be the subject of further research. Moreover, further effects on the interactions between the adaptive and innate immunity as well as between B and T cell lineages might explain the observed disease activation.
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Affiliation(s)
- Thomas Wehrum
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland.
| | - Lena-Alexandra Beume
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland
| | - Oliver Stich
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland
| | - Irina Mader
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland
| | - Mathias Mäurer
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland
| | - Adam Czaplinski
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland
| | - Cornelius Weiller
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland
| | - Sebastian Rauer
- From the Departments of Neurology and Neuroscience (T.W., L.-A.B., O.S., C.W., S.R.) and Neuroradiology (I.M.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurology (M.M.), Stiftung Juliusspital Würzburg, Germany; and Neurozentrum Bellevue (A.C.), Zürich, Switzerland
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Abstract
Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal patient management could be benefited by improved and well-validated prognostic and predictive imaging markers, as well as early response markers to identify successful treatment prior to changes in tumor size. To address these fundamental needs, newer MRI techniques including diffusion and perfusion imaging, MR spectroscopy, and positron emission tomography (PET) tracers beyond traditionally used 18-fluorodeoxyglucose are the subject of extensive ongoing investigations, with several promising avenues of added value already identified. These newer techniques provide a wealth of physiologic and metabolic information that may supplement standard MR evaluation, by providing the ability to monitor and characterize cellularity, angiogenesis, perfusion, pH, hypoxia, metabolite concentrations, and other critical features of malignancy. This chapter reviews standard and advanced imaging of brain metastases provided by computed tomography, MRI, and amino acid PET, focusing on potential biomarkers that can serve as problem-solving tools in the clinical management of patients with brain metastases.
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Affiliation(s)
- Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
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Wang Q, Zhang S, Cheng J, Liu W, Hui X. Radiologic Features and Surgical Strategy of Hemangioblastomas with Enhanced Cyst Wall. World Neurosurg 2017; 108:143-150. [DOI: 10.1016/j.wneu.2017.08.155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
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Lin X, Yu WY, Liauw L, Chander RJ, Soon WE, Lee HY, Tan K. Clinicoradiologic features distinguish tumefactive multiple sclerosis from CNS neoplasms. Neurol Clin Pract 2017; 7:53-64. [PMID: 29849229 PMCID: PMC5964866 DOI: 10.1212/cpj.0000000000000319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are limited data to guide clinicians in differentiating tumefactive multiple sclerosis (TMS) from CNS neoplasms. Identifying distinguishing features will inform diagnosis and management and avoid unnecessary diagnostic biopsy. Our study aimed to determine the clinical and radiologic features that differentiate TMS from glioma and CNS lymphoma (CNSL) in patients who present with tumefactive lesions. METHODS We retrospectively reviewed all patients with tumefactive lesions and histologically proven or clinically diagnosed TMS, glioma, or CNSL at our tertiary center from 1999 to 2012. Two independent blinded neuroradiologists rated MRI brain scans at presentation. We correlated patients' demographic, clinical, laboratory, and radiologic data to final diagnosis. RESULTS A total of 133 patients (10 TMS, 85 glioma, 38 CNSL) were analyzed. Patients with TMS were younger and a greater proportion were women. Presenting symptoms did not distinguish between diagnoses. TMS lesions were smaller compared to glioma and CNSL, had no or mild mass effect, and were always associated with contrast enhancement. Radiologic features that were more frequent in TMS lesions were incomplete rim (open-ring) enhancement, incomplete peripheral diffusion restriction, and mixed T2 signal and CT hypoattenuation of MRI-enhancing components (all p < 0.05). CONCLUSIONS Radiologic features but not presenting symptoms are useful in distinguishing TMS from CNS neoplasms.
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Affiliation(s)
- Xuling Lin
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Wai-Yung Yu
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Lishya Liauw
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Russell Jude Chander
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Weiling E Soon
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Hwei Yee Lee
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Kevin Tan
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
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Pyogenic brain abscess with atypical features resembling glioblastoma in advanced MRI imaging. Radiol Case Rep 2017; 12:365-370. [PMID: 28491190 PMCID: PMC5417631 DOI: 10.1016/j.radcr.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/28/2016] [Accepted: 12/19/2016] [Indexed: 12/28/2022] Open
Abstract
Differentiation between infectious and neoplastic brain processes is crucial for treatment planning. Advanced magnetic resonance imaging techniques, such as diffusion, perfusion, susceptibility weighted imaging, and magnetic resonance spectroscopy, enhance the imaging differences between these two pathologies. However, despite the utilization of these advanced techniques, the pathologic process may be confound by atypical findings. Here, we report a case of an autistic patient with multiple brain lesions with diffusion weighted imaging, susceptibility weighted imaging, and perfusion patterns resembling features of a multicentric glioblastoma, which were confirmed surgically, neuropathologically, and bacteriologically as brain abscesses. We discuss the differentiation of these different entities in the light of advanced magnetic resonance imaging techniques.
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Yield of Preoperative Whole-body CT in Patients Presenting with Single Brain Malignancy:: Experience at a Tertiary-care Center. Acad Radiol 2016; 23:600-4. [PMID: 27036076 DOI: 10.1016/j.acra.2015.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/07/2015] [Accepted: 12/11/2015] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES Single brain malignancy (SBM) often poses a diagnostic dilemma, with differential diagnosis of primary brain malignancy (PBM) versus metastasis commonly rendered. This study assesses the yield of preoperative computed tomography (CT) of the chest, abdomen, and pelvis (CTCAP) in patients with SBM. MATERIALS AND METHODS Institutional review board (IRB)-approved retrospective review of the imaging database at a tertiary-care center was performed for patients with magnetic resonance findings compatible with a diagnosis of SBM. Demographic information, lesion characteristics (location and size), and pathology were recorded. Findings of CTCAP for metastatic workup prior to SBM excisional biopsy were also documented, if performed. RESULTS Eighty-six of 92 patients with new diagnosis of SBM on MR imaging had subsequent lesion resection and pathology consistent with malignancy. PBM accounted for 51 cases (59%) and metastasis accounted for 35 cases (41%). When stratified by age group, PBM was more common in patients <50 years old (15 of 18 (83%)), whereas similar rates of PBM and metastatic disease were identified in older patients. When stratified by lesion size, PBM was more common in tumors ≥40 mm (25 of 31 (81%)), whereas similar rates of PBM and metastatic disease were identified in smaller lesions. Lung cancer was the most common CTCAP and pathology-confirmed source of metastatic SBM (68% and 66%, respectively). CONCLUSIONS The yield of preoperative CTCAP can be increased by targeting patients older than 50 years of age with SBMs smaller than 40 mm in size.
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Morris SA, Esquenazi Y, Tandon N. Pyogenic cerebral abscesses demonstrating facilitated diffusion. Clin Neurol Neurosurg 2016; 144:77-81. [PMID: 26999529 DOI: 10.1016/j.clineuro.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pyogenic cerebral abscesses are associated with high morbidity and mortality when treatment is delayed. Benign clinical presentation, as well as absence of restricted diffusion on MRI may contribute to missed diagnoses and delays. The authors sought to elucidate characteristics associated with facilitated diffusion on the MRIs of patients with pyogenic abscesses. PATIENTS AND METHODS The authors performed a 10-year retrospective review of prospectively attained data for patients undergoing mass resection by a single surgeon. RESULTS Our findings show that 3/33 (9%) patients with microbiological diagnoses of cerebral abscesses with a thin ring of contrast enhancement but minimal or no restricted diffusion MRI imaging. All causative organisms were hemolytic streptococci and none of the subjects received antibiotic therapy prior to specimen collection. A trend in these patients was the presence of diabetes and in conjunction with other studies that cite incomplete treatment as being associated with facilitated diffusion, we conjecture that impaired inflammatory responses in some patients may be associated with the absence of restricted diffusion. CONCLUSION With this in mind, clinicians must maintain a high index of suspicion when assessing patients with cystic, contrast enhancing masses. A prospective multicenter study to compile imaging along with other patient characteristics may help refine the non-invasive diagnostic criteria for brain abscesses.
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Affiliation(s)
- Saint-Aaron Morris
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
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Baudel JL, Dubée V, Palle J, Ait-Oufella H. Seizures, Paraplegia, and Cough Unveiling Disseminated Tuberculosis. Am J Med 2016; 129:e5-6. [PMID: 26231171 DOI: 10.1016/j.amjmed.2015.06.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Jean-Luc Baudel
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France; Université Pierre-et-Marie Curie, Paris, France
| | - Vincent Dubée
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France; Université Pierre-et-Marie Curie, Paris, France
| | - Juliette Palle
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France; Université Pierre-et-Marie Curie, Paris, France
| | - Hafid Ait-Oufella
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France; Université Pierre-et-Marie Curie, Paris, France.
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Maghsoudi B, Haddad H, Vatankhah P, Rasekhi A, Jaberi AR. Post-operative quadriplegia as the initial manifestation of tumefactive multiple sclerosis. Indian J Crit Care Med 2015. [PMID: 26195864 PMCID: PMC4478679 DOI: 10.4103/0972-5229.158281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Keung B, Huttner A. A 15-year-old girl with a rapidly progressing tumor-like lesion. Neuropathology 2015; 35:497-501. [PMID: 26011248 DOI: 10.1111/neup.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/20/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Benison Keung
- Department of Neurology, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anita Huttner
- Yale-New Haven Hospital, Yale Pathology, New Haven, Connecticut, USA
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Treabă CA, Bălaşa R, Podeanu DM, Simu IP, Buruian MM. Cerebral lesions of multiple sclerosis: is gadolinium always irreplaceable in assessing lesion activity? Diagn Interv Radiol 2015; 20:178-84. [PMID: 24378990 DOI: 10.5152/dir.2013.13313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to identify imaging characteristics on conventional magnetic resonance imaging that could predict multiple sclerosis (MS) brain lesion activity without contrast media administration. MATERIALS AND METHODS Magnetic resonance data sets of forty-two patients with relapsing-remitting MS who presented symptoms or signs suggestive of new disease activity were retrospectively reviewed. We classified the MS lesions into three types according to different patterns present on T2-weighted images and evaluated their relationship with the contrast uptake. Evolving aspects of each type of lesion were observed in 18 patients during a follow-up period ranging from nine to 36 months. RESULTS On T2-weighted images, only the pattern consisting of a thin border of decreased intensity compared with the lesion's center and perifocal edema (Type II) reached diagnostic accuracy in terms of its relationship with gadolinium enhancement (P = 0.006). The sensitivity was 0.461, and the specificity was 0.698. In contrast, enhancement was not significantly related to the pattern consisting of a lesion center that was homogeneously brighter than its periphery (Type I) or less-hyperintense T2 focal lesions with either homogeneous or inhomogeneous center (Type III) (P > 0.05 for both). CONCLUSION The assessment of MS lesion activity should include a careful evaluation of T2-weighted images in addition to contrast enhancement assessment. The presence of an accompanying peripheral thin rim of hypointensity on T2-weighted images related best with contrast enhancement and subsequent lesion activity and may represent an additional pattern for disease activity assessment when gadolinium examination is contraindicated or influenced by prior therapy.
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Affiliation(s)
- Constantina Andrada Treabă
- From the Departments of Radiology and Imaging (C.A.T. -e-mail: , D.M.P., I.P.S., M.M.B.), and Neurology (R.B.), Emergency County Clinical Hospital, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
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Wang LL, Leach JL, Breneman JC, McPherson CM, Gaskill-Shipley MF. Critical role of imaging in the neurosurgical and radiotherapeutic management of brain tumors. Radiographics 2015; 34:702-21. [PMID: 24819790 DOI: 10.1148/rg.343130156] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Lily L Wang
- From the Departments of Radiology (L.L.W., J.L.L., M.F.G.S.), Radiation Oncology (J.C.B.), and Neurosurgery (C.M.M.), University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH 45267-0761; Brain Tumor Center at the UC Neuroscience Institute and UC Cancer Institute (L.L.W., J.L.L., J.C.B., C.M.M., M.F.G.S.); and Departments of Radiology (J.L.L) and Radiation Oncology (J.C.B.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology. J Neurol 2014; 261:1902-10. [DOI: 10.1007/s00415-014-7437-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
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