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Ramos A, Hilario A. Standardized brain tumor reporting in the multidisciplinary spotlight: pros of the BT-RADS. Eur Radiol 2024:10.1007/s00330-024-10716-5. [PMID: 38583126 DOI: 10.1007/s00330-024-10716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Ana Ramos
- Radiology Department, Neuroradiology Section, University Hospital, 12 de Octubre, Madrid, Spain.
| | - Amaya Hilario
- Radiology Department, Neuroradiology Section, University Hospital, 12 de Octubre, Madrid, Spain
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Hilario A, Salvador E, Cardenas A, Romero J, Lechuga C, Chen Z, Martinez de Aragon A, Perez-Nuñez A, Hernandez-Lain A, Sepulveda J, Lagares A, Toldos O, Rodriguez-Gonzalez V, Ramos A. Low rCBV values in glioblastoma tumor progression under chemoradiotherapy. Neuroradiology 2024; 66:317-323. [PMID: 38183424 DOI: 10.1007/s00234-023-03279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/26/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE After standard treatment for glioblastoma, perfusion MRI remains challenging for differentiating tumor progression from post-treatment changes. Our objectives were (1) to correlate rCBV values at diagnosis and at first tumor progression and (2) to analyze the relationship of rCBV values at tumor recurrence with enhancing volume, localization of tumor progression, and time elapsed since the end of radiotherapy in tumor recurrence. METHODS Inclusion criteria were (1) age > 18 years, (2) histologically confirmed glioblastoma treated with STUPP regimen, and (3) tumor progression according to RANO criteria > 12 weeks after radiotherapy. Co-registration of segmented enhancing tumor VOIs with dynamic susceptibility contrast perfusion MRI was performed using Olea Sphere software. For tumor recurrence, we correlated rCBV values with enhancing tumor volume, with recurrence localization, and with time elapsed from the end of radiotherapy to progression. Analyses were performed with SPSS software. RESULTS Sixty-four patients with glioblastoma were included in the study. Changes in rCBV values between diagnosis and first tumor progression were significant (p < 0.001), with a mean and median decreases of 32% and 46%, respectively. Mean rCBV values were also different (p < 0.01) when tumors progressed distally (radiation field rCBV values of 1.679 versus 3.409 distally). However, changes and, therefore, low rCBV values after radiotherapy in tumor recurrence were independent of time. CONCLUSION Chemoradiation alters tumor perfusion and rCBV values may be decreased in the setting of tumor progression. Changes in rCBV values with respect to diagnosis, with low rCBV in tumor progression, are independent of time but related to the site of recurrence.
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Affiliation(s)
- A Hilario
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain.
| | - E Salvador
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Cardenas
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - J Romero
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - C Lechuga
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - Z Chen
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Martinez de Aragon
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Perez-Nuñez
- Department of Neurosurgery, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Hernandez-Lain
- Department of Neuropathology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - J Sepulveda
- Department of Medical Oncology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - O Toldos
- Department of Neuropathology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - V Rodriguez-Gonzalez
- Department of Radiation Oncology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Ramos
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
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Martín-Jiménez P, Sánchez-Tornero M, Llamas-Velasco S, Guerrero-Molina MP, González-Sánchez M, Herrero-San Martín A, Blanco-Palmero V, Calleja-Castaño P, Francisco-Gonzalo J, Hilario A, Ramos A, Salvador E, Toldos Ó, Hernández-Lain A, Pérez-Martínez DA, Villarejo-Galende A. Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series. Neurologia 2023; 38:550-559. [PMID: 37437655 DOI: 10.1016/j.nrleng.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/31/2020] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels. METHODS We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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Affiliation(s)
- P Martín-Jiménez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - M Sánchez-Tornero
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, Spain
| | - S Llamas-Velasco
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - M González-Sánchez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - A Herrero-San Martín
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - V Blanco-Palmero
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - A Hilario
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Ramos
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Salvador
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ó Toldos
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Hernández-Lain
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D A Pérez-Martínez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - A Villarejo-Galende
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
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Castaño-Leon AM, Sánchez Carabias C, Hilario A, Ramos A, Navarro-Main B, Paredes I, Munarriz PM, Panero I, Eiriz Fernández C, García-Pérez D, Moreno-Gomez LM, Esteban-Sinovas O, Garcia Posadas G, Gomez PA, Lagares A. Serum assessment of traumatic axonal injury: the correlation of GFAP, t-Tau, UCH-L1, and NfL levels with diffusion tensor imaging metrics and its prognosis utility. J Neurosurg 2023; 138:454-464. [PMID: 35901687 DOI: 10.3171/2022.5.jns22638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Diagnosis of traumatic axonal injury (TAI) is challenging because of its underestimation by conventional MRI and the technical requirements associated with the processing of diffusion tensor imaging (DTI). Serum biomarkers seem to be able to identify patients with abnormal CT scanning findings, but their potential role to assess TAI has seldomly been explored. METHODS Patients with all severities of traumatic brain injury (TBI) were prospectively included in this study between 2016 and 2021. They underwent blood extraction within 24 hours after injury and imaging assessment, including DTI. Serum concentrations of glial fibrillary acidic protein, total microtubule-associated protein (t-Tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and neurofilament light chain (NfL) were measured using an ultrasensitive Simoa multiplex assay panel, a digital form of enzyme-linked immunosorbent assay. The Glasgow Outcome Scale-Extended score was determined at 6 months after TBI. The relationships between biomarker concentrations, volumetric analysis of corpus callosum (CC) lesions, and fractional anisotropy (FA) were analyzed by nonparametric tests. The prognostic utility of the biomarker was determined by calculating the C-statistic and an ordinal regression analysis. RESULTS A total of 87 patients were included. Concentrations of all biomarkers were significantly higher for patients compared with controls. Although the concentration of the biomarkers was affected by the presence of mass lesions, FA of the CC was an independent factor influencing levels of UCH-L1 and NfL, which positioned these two biomarkers as better surrogates of TAI. Biomarkers also performed well in determining patients who would have had unfavorable outcome. NfL and the FA of the CC are independent complementary factors related to outcome. CONCLUSIONS UCH-L1 and NfL seem to be the biomarkers more specific to detect TAI. The concentration of NfL combined with the FA of the CC might help predict long-term outcome.
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Affiliation(s)
- Ana M Castaño-Leon
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | | | - Amaya Hilario
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Ana Ramos
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Blanca Navarro-Main
- 4Department of Psychiatry, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid; and
| | - Igor Paredes
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Pablo M Munarriz
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Irene Panero
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Carla Eiriz Fernández
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Daniel García-Pérez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Luis Miguel Moreno-Gomez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Olga Esteban-Sinovas
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Guillermo Garcia Posadas
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Pedro A Gomez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Alfonso Lagares
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid.,5Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Rodríguez-López A, Gimeno I, Vila S, Seoane A, Ballenilla F, Ramos A, Hilario A, Núñez N, Camacho A, Simón R. Mechanical Thrombectomy for Acute Stroke in a 2-Month-Old Patient and Review of the Literature in Infancy. Neuropediatrics 2022; 53:376-380. [PMID: 35512844 DOI: 10.1055/a-1844-8780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mechanical thrombectomy (MT) in pediatric stroke is supported by studies in adults, but there is controversy regarding younger patients. The main growth of intracranial vessels occurs up to 2 years when there can be more difficulties in MT.Description of the MT performed in a 2-month-old patient-the youngest infant published to date. We also review the literature on MT for stroke in infants.A 2-month-old patient presented with an awakening stroke secondary to an occlusion of the M1 segment of the left middle cerebral artery. A successful MT was performed with an aspiration device without clinically significant complications. An etiological study was completed, and neuroimaging showed focal cerebral arteriopathy. The 3-month outcome was excellent: the pediatric modified Rankin score was 0.Including this case, MT for acute stroke has been reported in only 10 infants. MT was successful in 90%, mostly using adult conventional stent retrievers. There were complications only in patients with mechanical circulatory support (MCS) devices; three patients died due to hemorrhagic transformation after MT and one patient died due to recurrent ischemic stroke.MT seems effective and safe in infants similarly to other pediatric ages. In children under 2 years of age, the presence of comorbidities requiring MCS devices is the main factor underlying poor prognosis.
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Affiliation(s)
| | - Isabel Gimeno
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sara Vila
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Andrea Seoane
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Federico Ballenilla
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Ramos
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Amaya Hilario
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Noemí Núñez
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Camacho
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rogelio Simón
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Alonso-Carrillo J, Hilario A, López-Alba A, Lalueza A. Dolor cervical y fiebre: un microorganismo inesperado. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arbizu J, Gállego Pérez-Larraya J, Hilario A, Gómez Grande A, Rubí S, Camacho V. Actualización en el diagnóstico de la encefalitis. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arbizu J, Gállego Pérez-Larraya J, Hilario A, Gómez Grande A, Rubí S, Camacho V. Update on the diagnosis of encephalitis. Rev Esp Med Nucl Imagen Mol 2022; 41:247-257. [DOI: 10.1016/j.remnie.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
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Park KY, Ozaki T, Kostynskyy A, Kortman H, Hilario A, Nicholson P, Agid R, Krings T, Pereira VM. Ticagrelor versus Clopidogrel in the Dual Antiplatelet Regimen for Intracranial Stenting or Flow-Diverter Treatment for Unruptured Cerebral Aneurysms: A Single-Center Cohort Study. AJNR Am J Neuroradiol 2021; 42:1638-1644. [PMID: 34244132 DOI: 10.3174/ajnr.a7216] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/25/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Ticagrelor is a novel P2Y12 antagonist, and little is known about its efficacy and safety in the endovascular treatment of aneurysms. This study evaluated the efficacy and safety of ticagrelor versus clopidogrel for stent-assisted coiling or flow-diversion treatment in patients with unruptured cerebral aneurysms. MATERIALS AND METHODS From November 2003 to February 2019, two hundred one patients (mean age, 57.5 years; 156 women) with 233 unruptured aneurysms underwent stent-assisted coiling or flow-diversion treatment. All patients received antiplatelet therapy of aspirin plus clopidogrel (clopidogrel group, 121 patients with 140 aneurysms) or aspirin plus ticagrelor (ticagrelor group, 80 patients with 93 aneurysms). The clinical and radiologic data in each group were retrospectively reviewed and compared. RESULTS Two hundred thirty-six procedures were performed, including stent-assisted coiling (n = 101) and flow diversion (n = 135). At 90 days, the primary outcome-a composite of any stroke and death-occurred in 9.9% of the clopidogrel group and 8.6% of the ticagrelor group (P = .822). Ischemic stroke occurred in 10 (7.0%) of the clopidogrel group and 7 (7.5%) of the ticagrelor group (P > .999). Disabling stroke occurred in 4 (2.8%) in the clopidogrel group and in 4 (4.3%) in the ticagrelor group (P = .716). Ninety-day death occurred in 3 (2.1%) in the clopidogrel group and 1 (1.1%) in the ticagrelor group (P > .999). Any bleeding at 90 days occurred in 13 (9.2%) in the clopidogrel group and 6 (6.5%) in the ticagrelor group (P = .479). CONCLUSIONS Ticagrelor appears to be as effective and safe as clopidogrel in stent-assisted coiling or flow-diversion treatment for unruptured cerebral aneurysms.
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Affiliation(s)
- K Y Park
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neurosurgery (K.Y.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - T Ozaki
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Kostynskyy
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - H Kortman
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Radiology (H.K.), Elisabeth-TweeSteden Ziekenhuis St. Elisabeth Hospital, Tilburg, the Netherlands
| | - A Hilario
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - P Nicholson
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - R Agid
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - T Krings
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - V M Pereira
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Navarro-Main B, Castaño-León AM, Hilario A, Lagares A, Rubio G, Periañez JA, Rios-Lago M, Inertia Group Collaborators. Apathetic symptoms and white matter integrity after traumatic brain injury. Brain Inj 2021; 35:1043-1053. [PMID: 34357825 DOI: 10.1080/02699052.2021.1953145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The aim of the study was twofold. First, to study the relationship among apathy in the long term, initial clinical measures, and standard outcome scores after traumatic brain injury (TBI). Second, to describe white matter integrity correlates of apathy symptoms. RESEARCH DESIGN Correlational study. Methods and Procedures: Correlation and Bayesian networks analyses were performed in a sample of 40 patients with moderate to severe TBI in order to identify the relationship among clinical variables, functionality, and apathy. A diffusion tensor imaging study was developed in 25 participants to describe correlations between fractional anisotropy (FA) measures and apathetic symptoms. MAIN OUTCOMES AND RESULTS Correlation analysis revealed associations between pairs of variables as apathy in the long term and functional score at discharge from hospital. Bayesian network illustrated the relevant role of axonal injury mediating the relationship between apathy and initial clinical variables. FA in the superior longitudinal fasciculus, the inferior longitudinal fasciculus, and the internal capsule were negatively correlated with apathy measures. Widespread brain areas showed positive correlations between FA and apathy. CONCLUSIONS These results highlight the relevance of white matter integrity measures in initial assessment after TBI and its relationship with apathetic manifestations in the chronic phase.
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Affiliation(s)
- B Navarro-Main
- 12 De Octubre Hospital.,I+12 Investigation Institute, INERTIA Research Group.,Faculty of Psychology, Doctoral School UNED
| | - A M Castaño-León
- 12 De Octubre Hospital.,I+12 Investigation Institute, INERTIA Research Group
| | - A Hilario
- 12 De Octubre Hospital.,I+12 Investigation Institute, INERTIA Research Group
| | - A Lagares
- 12 De Octubre Hospital.,I+12 Investigation Institute, INERTIA Research Group
| | - G Rubio
- 12 De Octubre Hospital.,I+12 Investigation Institute, INERTIA Research Group
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11
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Castaño-Leon AM, Cicuendez M, Navarro-Main B, Paredes I, Munarriz PM, Hilario A, Ramos A, Gomez PA, Lagares A. Traumatic axonal injury: is the prognostic information produced by conventional MRI and DTI complementary or supplementary? J Neurosurg 2021; 136:242-256. [PMID: 34214979 DOI: 10.3171/2020.11.jns203124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A traumatic axonal injury (TAI) diagnosis has traditionally been based on conventional MRI, especially on those sequences with a higher sensitivity to edema and blood degradation products. A more recent technique, diffusion tensor imaging (DTI), can infer the microstructure of white matter (WM) due to the restricted diffusion of water in organized tissues. However, there is little information regarding the correlation of the findings obtained by both methods and their use for outcome prognosis. The main objectives of this study were threefold: 1) study the correlation between DTI metrics and conventional MRI findings; 2) evaluate whether the prognostic information provided by the two techniques is supplementary or complementary; and 3) determine the incremental value of the addition of these variables compared to a traditional prognostic model. METHODS The authors studied 185 patients with moderate to severe traumatic brain injury (TBI) who underwent MRI with DTI study during the subacute stage. The number and volume of lesions in hemispheric subcortical WM, corpus callosum (CC), basal ganglia, thalamus, and brainstem in at least four conventional MRI sequences (T1-weighted, T2-weighted, FLAIR, T2* gradient recalled echo, susceptibility-weighted imaging, and diffusion-weighted imaging) were determined. Fractional anisotropy (FA) was measured in 28 WM bundles using the region of interest method. Nonparametric tests were used to evaluate the colocalization of macroscopic lesions and FA. A multivariate logistic regression analysis was performed to assess the independent prognostic value of each neuroimaging modality after adjustment for relevant clinical covariates, and the internal validation of the model was evaluated in a contemporary cohort of 92 patients. RESULTS Differences in the lesion load between patients according to their severity and outcome were found. Colocalization of macroscopic nonhemorrhagic TAI lesions (not microbleeds) and lower FA was limited to the internal and external capsule, corona radiata, inferior frontooccipital fasciculus, CC, and brainstem. However, a significant association between the FA value and the identification of macroscopic lesions in distant brain regions was also detected. Specifically, lower values of FA of some hemispheric WM bundles and the splenium of the CC were related to a higher number and volume of hyperintensities in the brainstem. The regression analysis revealed that age, motor score, hypoxia, FA of the genu of the CC, characterization of TAI lesions in the CC, and the presence of thalamic/basal ganglia lesions were independent prognostic factors. The performance of the proposed model was higher than that of the IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) model in the validation cohort. CONCLUSIONS Very limited colocalization of hyperintensities (none for microbleeds) with FA values was discovered. DTI and conventional MRI provide complementary prognostic information, and their combination can improve the performance of traditional prognostic models.
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Affiliation(s)
| | - Marta Cicuendez
- 2Department of Neurosurgery, Hospital Universitario Vall d'Hebron, Universidad de Barcelona, Passeig de la Vall d'Hebron, Barcelona, Spain
| | | | - Igor Paredes
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Pablo M Munarriz
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Amaya Hilario
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda de Cordoba SN, Madrid; and
| | - Ana Ramos
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda de Cordoba SN, Madrid; and
| | - Pedro A Gomez
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Alfonso Lagares
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
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Martín-Jiménez P, Sánchez-Tornero M, Llamas-Velasco S, Guerrero-Molina MP, González-Sánchez M, Herrero-San Martín A, Blanco-Palmero V, Calleja-Castaño P, Francisco-Gonzalo J, Hilario A, Ramos A, Salvador E, Toldos Ó, Hernández-Lain A, Pérez-Martínez DA, Villarejo-Galende A. Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series. Neurologia 2021; 38:S0213-4853(21)00033-5. [PMID: 33726968 DOI: 10.1016/j.nrl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels. METHODS We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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Affiliation(s)
- P Martín-Jiménez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - M Sánchez-Tornero
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, España
| | - S Llamas-Velasco
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - M P Guerrero-Molina
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M González-Sánchez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - A Herrero-San Martín
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - V Blanco-Palmero
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Francisco-Gonzalo
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Hilario
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Ramos
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Salvador
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - Ó Toldos
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Hernández-Lain
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - D A Pérez-Martínez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
| | - A Villarejo-Galende
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
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Mahammedi A, Ramos A, Bargalló N, Gaskill M, Kapur S, Saba L, Carrete H, Sengupta S, Salvador E, Hilario A, Revilla Y, Sanchez M, Perez-Nuñez M, Bachir S, Zhang B, Oleaga L, Sergio J, Koren L, Martin-Medina P, Wang L, Benegas M, Ostos F, Gonzalez-Ortega G, Calleja P, Udstuen G, Williamson B, Khandwala V, Chadalavada S, Woo D, Vagal A. Brain and Lung Imaging Correlation in Patients with COVID-19: Could the Severity of Lung Disease Reflect the Prevalence of Acute Abnormalities on Neuroimaging? A Global Multicenter Observational Study. AJNR Am J Neuroradiol 2021; 42:1008-1016. [PMID: 33707278 DOI: 10.3174/ajnr.a7072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms. MATERIALS AND METHODS In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to >75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement). RESULTS A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P < .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P < .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P = .01) in the lungs. A threshold of the CT lung severity score of >8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation. CONCLUSIONS The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome.
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Affiliation(s)
- A Mahammedi
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - A Ramos
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Bargalló
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Gaskill
- Departments of Neuroradiology (L.O., N.B.), Hospital Clínic de Barcelona, Sunyer Biomedical Research Institute, Barcelona, Spain
| | - S Kapur
- Cardiopulmonary Imaging, (S.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - L Saba
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - H Carrete
- Department of Neuroradiology (H.C.), Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - S Sengupta
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - E Salvador
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Hilario
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Y Revilla
- Cardiopulmonary Imaging (Y.R., M.P.-N.) Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Sanchez
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - M Perez-Nuñez
- Cardiopulmonary Imaging (Y.R., M.P.-N.) Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - L Oleaga
- Departments of Neuroradiology (L.O., N.B.), Hospital Clínic de Barcelona, Sunyer Biomedical Research Institute, Barcelona, Spain
| | - J Sergio
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - L Koren
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Martin-Medina
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Wang
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Benegas
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - F Ostos
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Gonzalez-Ortega
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Calleja
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Udstuen
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - B Williamson
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - V Khandwala
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | - D Woo
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - A Vagal
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
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14
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Castaño-Leon AM, Paredes I, Munarriz PM, Jiménez-Roldán L, Hilario A, Calatayud M, Hernandez-Lain A, Garcia E, Garcia A, Lagares A, Alén JF. Endoscopic Transnasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Comparison to the Microscopic Approach Cohort by Propensity Score Analysis. Neurosurgery 2020. [DOI: 10.1093/neuros/nyz201_s35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Castaño-Leon AM, Paredes I, Munarriz PM, Jiménez-Roldán L, Hilario A, Calatayud M, Hernandez-Lain A, Garcia E, Garcia A, Lagares A, Alén JF. Endoscopic Transnasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Comparison to the Microscopic Approach Cohort by Propensity Score Analysis. Neurosurgery 2020; 86:348-356. [PMID: 31173138 DOI: 10.1093/neuros/nyz201] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite some evidence for the adoption of endoscopic transnasal trans-sphenoidal surgery (ETSS) for pituitary adenomas, the advantages of this technique over the traditional approach have not been robustly confirmed. OBJECTIVE To compare ETSS with the microscopic sublabial trans-septal trans-sphenoidal surgery (MTSS) for pituitary adenomas. METHODS We retrospectively reviewed 2 cohorts of ETSS and MTSS performed at our institution from 1995 to 2017. Patient characteristics, surgical data, and outcomes were recorded prospectively. We performed a univariate and multivariable analysis to determine the best surgical approach. To improve the quality of the results, we matched the distribution of patient characteristics between groups by propensity score (PS) method. RESULTS A total of 187 procedures (90 MTSS, 97 ETSS) were reviewed. We found better results in the ETSS group in terms of gross total resection (P = .002) and hormone-excess secretion control (P = .014). There was also a lower incidence of cerebrospinal fluid leakage (P = .039), transitory diabetes insipidus (P = .028), and postoperative hypopituitarism (P = .045), as well as a shorter hospital length of stay (P < .001). After PS matching, we confirmed by multivariable logistic regression analysis an increased odds ratio of gross total resection for the ETSS (3.910; 95% CI 1.720-8.889; P = .001). CONCLUSION By PS method, our results suggest that the ETSS provides advantages over the traditional MTSS approach for tumor resection. Better control of secreting tumors and a lower rate of most complications also support the selection of the ETSS approach for the treatment of pituitary adenomas.
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Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Jiménez-Roldán
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Amaya Hilario
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Calatayud
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Aurelio Hernandez-Lain
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Ester Garcia
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfredo Garcia
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose F Alén
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Castaño-Leon AM, Cicuendez M, Navarro-Main B, Munarriz PM, Paredes I, Cepeda S, Hilario A, Ramos A, Gómez PA, Lagares A. PREMIO SIXTO OBRADOR SENEC 2019: El uso de la secuencia Tensor de difusión como herramienta pronóstica en los pacientes con traumatismo craneoencefálico grave y moderado. Parte II: Análisis longitudinal de las características del Tensor de difusión y su relación con la evolución de los pacientes. Neurocirugia (Astur) 2020; 31:231-248. [DOI: 10.1016/j.neucir.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
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Pérez-Jacoiste Asín MA, Calleja-Castaño P, Hilario A. Lumbosacral Radiculopathy as the Clinical Presentation of Neurocysticercosis. Am J Trop Med Hyg 2020; 102:1166-1167. [PMID: 32519649 PMCID: PMC7253111 DOI: 10.4269/ajtmh.19-0757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Amaya Hilario
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Castaño-Leon AM, Cicuendez M, Navarro-Main B, Munarriz PM, Paredes I, Cepeda S, Hilario A, Ramos A, Gómez PA, Lagares A. Sixto Obrador SENEC prize 2019: Utility of diffusion tensor imaging as a prognostic tool in moderate to severe traumatic brain injury. Part I. Analysis of DTI metrics performed during the early subacute stage. Neurocirugia (Astur) 2020; 31:132-145. [PMID: 31948842 DOI: 10.1016/j.neucir.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Traumatic axonal injury (TAI) contributes significantly to mortality and morbidity after traumatic brain injury (TBI). Its identification is still a diagnostic challenge because of the limitations of conventional imaging techniques to characterized it. Diffusion tensor imaging (DTI) can indirectly identify areas of damaged white matter integrity by detecting water molecule diffusion alterations. Our main objective is to characterize the TAI using DTI at the early subacute stage in our series of moderate to severe TBI patients and to evaluate if there is a relationship between the information provided by the DTI and patient's outcome. MATERIALS AND METHODS We have obtained DTI data from 217 patients with moderate to severe TBI acquired at a median of 19 days after TBI, and patient DTI metrics were compared with data obtained from 58 age-matched healthy controls. Region of interest method was applied to obtain mean fractional anisotropy (FA) value in 28 white matter fiber bundles susceptible to TAI. RESULTS Our main results were that when we compared patients with controls, patients, regardless of TBI severity, showed significantly reduced mean FA in almost all region of interest measured. We found statistically significant correlation between FA metrics and some clinical characteristics. Additionally, the FA values of the three portions of Corpus callosum, Cingulum and cerebral peduncles measured at the early subacute stage were highly associated with outcome assessed at hospital discharge and at 6 and 12 months after TBI. CONCLUSIONS We conclude that DTI is a useful tool to characterize TAI and the detection of FA reduction in the subacute stage after TBI is associated with long-term unfavorable outcome.
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Affiliation(s)
- Ana M Castaño-Leon
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - Marta Cicuendez
- Servicio de Neurocirugía, Hospital Universitario Vall d'Hebron, Universidad de Barcelona, Barcelona, España
| | - Blanca Navarro-Main
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Pablo M Munarriz
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Igor Paredes
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Santiago Cepeda
- Servicio de Neurocirugía, Hospital Universitario Río Hortega, Universidad de Valladolid, Valladolid, España
| | - Amaya Hilario
- Servicio de Neurorradiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Ana Ramos
- Servicio de Neurorradiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Pedro A Gómez
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Alfonso Lagares
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
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Cicuendez M, Castaño-León A, Ramos A, Hilario A, Gómez PA, Lagares A. The added prognostic value of magnetic resonance imaging in traumatic brain injury: The importance of traumatic axonal injury when performing ordinal logistic regression. J Neuroradiol 2019; 46:299-306. [DOI: 10.1016/j.neurad.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/30/2018] [Accepted: 08/15/2018] [Indexed: 12/01/2022]
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Castaño-Leon AM, Cicuendez M, Navarro B, Paredes I, Munarriz PM, Cepeda S, Hilario A, Ramos A, Gomez PA, Lagares A. Longitudinal Analysis of Corpus Callosum Diffusion Tensor Imaging Metrics and Its Association with Neurological Outcome. J Neurotrauma 2019; 36:2785-2802. [PMID: 30963801 DOI: 10.1089/neu.2018.5978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Traumatic axonal injury (TAI) is the main cause of cognitive and psychological disfunction after a traumatic brain injury (TBI). Diffusion tensor imaging (DTI) is considered a useful technique for indirect assessment of white matter (WM) integrity after a TBI. Scattered WM alterations and its relationship with patient severity have been discovered in normal appearing conventional magnetic resonance imaging (MRI) studies based on DTI sequences. However, there is a lack of large sample studies on the longitudinal changes of DTI metrics to be used to determine the temporal profile after head injury and its association with patient outcome. We performed a prospective observational study in 118 moderate-to-severe TBI patients. The study included clinical outcome assessment based on the Glasgow Outcome Scale Extended (GOSE) and serial DTI studies in the early subacute setting (< 60 days) and 6 and 12 months after injury. Fractional anisotropy (FA) and axial and radial diffusivities (AD and RD, respectively) were measured in the three portions of corpus callosum (genu, body, splenium) at each time-point and compared with normalized values from an age-matched control group. Longitudinal FA analysis and its correlation with patient improvement also was done by non-parametric testing and ordinal regression analysis. Our main results indicated that between all the time-points, dynamic changes in DTI metrics in all three portions of corpus callosum were detected, but TBI patients continued to show significantly lower FA and AD values and higher RD values compared with controls. We also have discovered differences in the change of DTI metrics among different time-points in patient subgroups according with their outcome improvement. In conclusion, even without normalization of DTI metrics in the long-term, knowledge of the temporal profile of change in DTI metrics can provide important information about patients' clinical recovery after TBI.
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Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Marta Cicuendez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Blanca Navarro
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Amaya Hilario
- Department of Radiology, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Ana Ramos
- Department of Radiology, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Pedro A Gomez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Complutense University of Madrid, Madrid, Spain
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Sepulveda-Sanchez JM, Gil Gil MJ, Alonso M, Vaz Salgado MÁ, Vicente E, Mesia Barroso C, Rodriguez Sanchez A, Durán G, De Las Penas R, Muñoz-Langa J, de Velasco G, Hernandez-Lain A, Hilario A, Navarro LM, Benavides M, Oleaga L, Cantero D, Ruano Y, Sanchez-Gomez P, Pineda E. Phase II trial of palbociclib in recurrent RB-positive anaplastic oligodendroglioma: A Spanish group for research in neurooncology (GEINO) trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2038 Background: The pRB-dependent cell cycle checkpoint is altered in the vast majority of anaplastic oligodendrogliomas (AO), either by homozygous deletion or by hypermethylation of CDKN2A and/or CDKN2B, or by amplification and/or overexpression of CDK4. Palbociclib is an oral inhibitor of CDK4 and 6 that has already been shown to be highly active in breast cancer. Methods: We conducted a multicenter, open-label, phase II trial evaluating efficacy and safety of Palbociclib in patients with AO that progressed to radiotherapy and more than one chemotherapy regimen containing Temozolomide and/or Lomustine. Inclusion criteria included: histologically and molecularly confirmed grade III oligodendroglioma (WHO 2016 classification, IDH1/2 mutation and 1p/19 codeletion were mandatory), recurrence after radiotherapy and 1 or 2 chemotherapy regimens and conserved RB protein expression by immunohistochemistry (IHC). Patients were treated with Palbociclib 125 mg/daily 3 weeks on/1off. The primary objective of the study was progression-free survival at 6 months (6M-PFS). Results: Between October 2015 and September 2018, 34 patients were enrolled across ten hospitals. The study was stopped early secondary to lack of efficacy, with 74% of evaluable patients progressing within 6 months. Number of patients alive and free from progression at 6 months after the enrollment was 9 (26%) out of the first 34 patients, below the minimum number required (18 out of 40) to consider Palbociclib as an active drug in this population. With a median follow-up of 11.2 months, the median PFS was 3 months (95% CI: 2.5-3.5 months). Median overall survival (OS) was 23.1 months (95% CI: 17.2-25 months). There were no partial or complete responses and only 11 patients (32%) achieved stable disease as best response. Palbociclib was well tolerated with neutropenia (Grade 3 or 4: 40%) and thrombocytopenia (Grade 3 or 4: 15%) as the most common adverse effects (AEs). Both AEs had no significant impact since there were no episodes of febrile neutropenia or bleeding. Conclusions: Despite the good tolerance and drug exposure, Palbociclib monotherapy did not show favorable activity in recurrent AO. Clinical trial information: NCT02530320.
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Affiliation(s)
| | - Miguel J. Gil Gil
- Breast Cancer Unit & Medical Oncology Department, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
| | - Miriam Alonso
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Elena Vicente
- Complejo Hospitalario Insular, Las Palmas de Gran Canaria, Spain
| | | | | | - Gema Durán
- Complejo Hospitalario Regional de Málaga, Malaga, Spain
| | | | | | - Guillermo de Velasco
- Department of Medical Oncology, University Hospital 12 de Octubre, i + 12, Madrid, Spain, Madrid, Spain
| | | | | | - L Miguel Navarro
- Department of Medical Oncology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Manuel Benavides
- Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | | | | | | | | | - Estela Pineda
- Medical Oncology, Hospital Clinic Barcelona, Barcelona, Spain
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Castaño Leon AM, Cicuendez M, Navarro B, Munarriz PM, Cepeda S, Paredes I, Hilario A, Ramos A, Gómez PA, Lagares A. What Can Be Learned from Diffusion Tensor Imaging from a Large Traumatic Brain Injury Cohort?: White Matter Integrity and Its Relationship with Outcome. J Neurotrauma 2018; 35:2365-2376. [DOI: 10.1089/neu.2018.5691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ana María Castaño Leon
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Marta Cicuendez
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Blanca Navarro
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Pablo M. Munarriz
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Amaya Hilario
- Department of Radiology, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Ana Ramos
- Department of Radiology, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Pedro Antonio Gómez
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, 12 Octubre University Hospital, Complutense University, Madrid, Spain
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Hilario A, Hernandez-Lain A, Sepulveda JM, Lagares A, Perez-Nuñez A, Ramos A. Perfusion MRI grading diffuse gliomas: Impact of permeability parameters on molecular biomarkers and survival. Neurocirugia (Astur) 2018; 30:11-18. [PMID: 30143443 DOI: 10.1016/j.neucir.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/04/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Our objectives were: (1) compare dynamic susceptibility-weighted (DSC) and dynamic contrast-enhanced (DCE) permeability parameters, (2) evaluate diagnostic accuracy of DSC and DCE discriminating high- and low-grade tumors, (3) analyze relationship of permeability parameters with overall (OS) and progression-free survival (PFS) and (4) assess differences in high-grade tumors classified according to molecular biomarkers. MATERIALS AND METHODS 49 patients with histologically proved diffuse gliomas underwent DSC and DCE imaging. Parametric maps of cerebral blood volume (CBV), CBV-leakage corrected, volume transfer coefficient (Ktrans), fractional volume of the extravascular extracellular space (EES) (Ve), fractional blood plasma volume (Vp) and rate constant between EES and blood plasma (Kep) were calculated. High-grade gliomas were also classified according to isocitrate dehydrogenase (IDH), alpha-thalassemia/mental retardation syndrome X-linked (ATRX) and O6-methylguanine-dna-methyltransferase promoter methylation (MGMT) status. RESULTS There is correlation between parameters leakage, Ktrans and Vp. ROC curve analysis showed significance in both Ktrans and Ve for glioma grading. Threshold value of 0.075 for Ve generated the best combination of sensitivity (80%) and specificity (75%) in tumor gradation. Leakage was the only permeability parameter related to OS (P=0.006) and PFS (0.012); with prolonged survival for leakage values lower than 1.2. IDH-mutated high-grade tumors showed lower leakage and Ktrans values. High-grade tumors with loss of ATRX presented lower leakage and Vp values. CONCLUSIONS Both DSC and DCE permeability parameters serve as non-invasive method for glioma grading. Leakage was the unique permeability parameter related to survival and the best discriminating high-grade gliomas classified according to IDH and ATRX status.
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Affiliation(s)
- Amaya Hilario
- Department of Radiology, Neuroradiology Section, Universitary Hospital 12 de Octubre, Madrid, Spain.
| | | | | | - Alfonso Lagares
- Department of Neurosurgery, Universitary Hospital 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Department of Neurosurgery, Universitary Hospital 12 de Octubre, Madrid, Spain
| | - Ana Ramos
- Department of Radiology, Neuroradiology Section, Universitary Hospital 12 de Octubre, Madrid, Spain
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Cicuendez M, Castaño-León A, Ramos A, Hilario A, Gómez PA, Lagares A. [Magnetic resonance in traumatic brain injury: A comparative study of the different conventional magnetic resonance imaging sequences and their diagnostic value in diffuse axonal injury]. Neurocirugia (Astur) 2017; 28:266-275. [PMID: 28728755 DOI: 10.1016/j.neucir.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/29/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the identification capability of traumatic axonal injury (TAI) by different sequences on conventional magnetic resonance (MR) studies in traumatic brain injury (TBI) patients. MATERIAL AND METHODS We retropectevely analyzed 264 TBI patients to whom a MR had been performed in the first 60 days after trauma. All clinical variables related to prognosis were registered, as well as the data from the initial computed tomography. The MR imaging protocol consisted of a 3-plane localizer sequence T1-weighted and T2-weighted fast spin-echo, FLAIR and gradient-echo images (GRET2*). TAI lesions were classified according to Gentry and Firsching classifications. We calculated weighted kappa coefficients and the area under the ROC curve for each MR sequence. A multivariable analyses was performed to correlate MR findings in each sequence with the final outcome of the patients. RESULTS TAI lesions were adequately visualized on T2, FLAIR and GRET2* sequences in more than 80% of the studies. Subcortical TAI lesions were well on FLAIR and GRET2* sequences visualized hemorrhagic TAI lesions. We saw that these MR sequences had a high inter-rater agreement for TAI diagnosis (0.8). T2 sequence presented the highest value on ROC curve in Gentry (0.68, 95%CI: 0.61-0.76, p<0.001, Nagerlkerke-R2 0.26) and Firsching classifications (0.64, 95%CI 0.57-0.72, p<0.001, Nagerlkerke-R2 0.19), followed by FLAIR and GRET2* sequences. Both classifications determined by each of these sequences were associated with poor outcome after performing a multivariable analyses adjusted for prognostic factors (p<0.02). CONCLUSIONS We recommend to perform conventional MR study in subacute phase including T2, FLAIR and GRET2* sequences for visualize TAI lesions. These MR findings added prognostic information in TBI patients.
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Affiliation(s)
- Marta Cicuendez
- Departamento de Neurocirugía, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - Ana Castaño-León
- Departamento de Neurocirugía, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, España
| | - Ana Ramos
- Departamento de Neurorradiología, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, Spain
| | - Amaya Hilario
- Departamento de Neurorradiología, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gómez
- Departamento de Neurocirugía, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, España
| | - Alfonso Lagares
- Departamento de Neurocirugía, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, España
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25
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Cicuendez M, Castaño-León A, Ramos A, Hilario A, Gómez PA, Lagares A. Prognostic value of corpus callosum injuries in severe head trauma. Acta Neurochir (Wien) 2017; 159:25-32. [PMID: 27796652 DOI: 10.1007/s00701-016-3000-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study was performed to investigate the relationship between corpus callosum (CC) injury and prognosis in traumatic axonal injury (TAI). METHOD We retrospectively reviewed 264 patients with severe head trauma who underwent a conventional MR imaging in the first 60 days after injury. They were selected from a prospectively collected database of 1048 patients with severe head trauma admitted in our hospital. TAI lesions were defined as areas of increased signal intensity on T2 and FLAIR or areas of decreased signal on gradient-echo T2. We attempted to determine whether any MR imaging findings of TAI lesions at CC could be related to prognosis. Neurological impairment was assessed at 1 year after injury by means of GOS-E (good outcome being GOS-E 4/5 and bad outcome being GOS-E <4). We adjusted the multivariable analysis for the prognostic factors according to the IMPACT studies: the Core model (age, motor score at admission, and pupillary reactivity) and the Extended model (including CT information and second insults). RESULTS We found 97 patients (37 %) with TAI at CC and 167 patients (63 %) without CC lesions at MR. A total of 62 % of the patients with CC lesions had poor outcome, whereas 38 % showed good prognosis. The presence of TAI lesions at the corpus callosum was associated with poor outcome 1 year after brain trauma (p < 0.001, OR 3.8, 95 % CI: 2.04-7.06). The volume of CC lesions measured on T2 and FLAIR sequences was negatively correlated with the GOS-E after adjustment for independent prognostic factors (p = 0.01, OR 2.23, 95 % CI:1.17-4.26). Also the presence of lesions at splenium was statistically related to worse prognosis (p = 0.002, OR 8.1, 95 % CI: 2.2-29.82). We did not find statistical significance in outcome between hemorrhagic and non-hemorrhagic CC lesions. CONCLUSIONS The presence of CC is associated with a poor outcome. The total volume of the CC lesion is an independent prognostic factor for poor outcome in severe head trauma.
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Affiliation(s)
- Marta Cicuendez
- Department of Neurosurgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Ana Castaño-León
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Ramos
- Department of Neuroradiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Amaya Hilario
- Department of Neuroradiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gómez
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Hernandez-Lain A, Hilario A, Sepulveda JM, Cantero D, Ramos A, Perez-Nuñez A. Temozolomide induces radiologic pseudoprogression and tumor cell vanishing in oligodendroglioma. Neurology 2016; 87:114-5. [PMID: 27251883 DOI: 10.1212/wnl.0000000000002810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/24/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Amaya Hilario
- From Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Diana Cantero
- From Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Ramos
- From Hospital Universitario 12 de Octubre, Madrid, Spain
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Hilario A, Sepulveda JM, Hernandez-Lain A, Salvador E, Koren L, Manneh R, Ruano Y, Perez-Nuñez A, Lagares A, Ramos A. Leakage decrease detected by dynamic susceptibility-weighted contrast-enhanced perfusion MRI predicts survival in recurrent glioblastoma treated with bevacizumab. Clin Transl Oncol 2016; 19:51-57. [PMID: 27026567 DOI: 10.1007/s12094-016-1502-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/09/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE In glioblastoma, tumor progression appears to be triggered by expression of VEGF, a regulator of blood vessel permeability. Bevacizumab is a monoclonal antibody that inhibits angiogenesis by clearing circulating VEGF, resulting in a decline in the contrast-enhancing tumor, which does not always correlate with treatment response. Our objectives were: (1) to evaluate whether changes in DSC perfusion MRI-derived leakage could predict survival in recurrent glioblastoma, and (2) to estimate whether leakage at baseline was related to treatment outcome. MATERIALS AND METHODS We retrospectively analyzed DSC perfusion MRI in 24 recurrent glioblastomas treated with bevacizumab as second line chemotherapy. Leakage at baseline and changes in maximum leakage between baseline and the first follow-up after treatment were selected for quantitative analysis. Survival univariate analysis was made constructing survival curves using Kaplan-Meier method and comparing subgroups by log rank probability test. RESULTS Leakage reduction at 8 weeks after initiation of bevacizumab treatment had a significant influence on overall survival (OS) and progression-free survival (PFS). Median OS and PFS were 2.4 and 2.8 months longer for patients with leakage reduction at the first follow-up. Higher leakage at baseline was associated with leakage reduction after treatment. Odds ratio of treatment response was 9 for patients with maximum leakage at baseline >5. CONCLUSIONS Leakage decrease may predict OS and PFS in recurrent glioblastomas treated with bevacizumab. Leakage reduction postulates as a potential biomarker for treatment response evaluation. Leakage at baseline seems to predict response to treatment, but was not independently associated with survival.
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Affiliation(s)
- A Hilario
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain.
| | - J M Sepulveda
- Department of Medical Oncology, Hospital 12 de Octubre, Madrid, Spain
| | - A Hernandez-Lain
- Department of Neuropathology, Hospital 12 de Octubre, Madrid, Spain
| | - E Salvador
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - L Koren
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - R Manneh
- Department of Medical Oncology, Hospital 12 de Octubre, Madrid, Spain
| | - Y Ruano
- Department of Neuropathology, Hospital 12 de Octubre, Madrid, Spain
| | - A Perez-Nuñez
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
| | - A Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
| | - A Ramos
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
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Gómez-Cibeira E, Ivanovic-Barbeito Y, Gutiérrez-Martínez E, Morales E, Abradelo M, Hilario A, Ramos A, Ruiz-Morales J, Villarejo-Galende A. Eculizumab-related progressive multifocal leukoencephalopathy. Neurology 2015; 86:399-400. [PMID: 26718572 DOI: 10.1212/wnl.0000000000002312] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/06/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | | | | | - Amaya Hilario
- From Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Ana Ramos
- From Hospital Universitario Doce de Octubre, Madrid, Spain
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Sepulveda-Sanchez J, Ramos A, Hilario A, DE Velasco G, Castellano D, Garcia DE LA Torre M, Rodon J, Lahn MF. Brain perfusion and permeability in patients with advanced, refractory glioblastoma treated with lomustine and the transforming growth factor-β receptor I kinase inhibitor LY2157299 monohydrate. Oncol Lett 2015; 9:2442-2448. [PMID: 26137087 DOI: 10.3892/ol.2015.3106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 03/04/2015] [Indexed: 11/06/2022] Open
Abstract
Transforming growth factor-β (TGF-β) signaling is associated with tumor progression and vascularization in malignant glioma. In the present study, magnetic resonance imaging was used to evaluate changes in the size and vascularity of glioblastomas in 12 patients who were treated with lomustine and the novel inhibitor of TGF-β signaling, LY2157299 monohydrate. A response in tumor size was observed in 2 of the 12 patients; in 1 of these 2 patients, a reduction in vascular permeability and perfusion was also detected. The effect was observed following 4 cycles of treatment (~3 months). Changes in vascularity have not previously been attributed to treatment with lomustine; therefore, the effect may be associated with LY2157299 treatment. LY2157299 does not appear to have an anti-angiogenic effect when combined with lomustine, and hence may have a different mechanism of action profile compared with anti-angiogenic drugs.
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Affiliation(s)
| | - Ana Ramos
- Department of Neuroradiology, University Hospital October 12, Madrid 28041, Spain
| | - Amaya Hilario
- Department of Neuroradiology, University Hospital October 12, Madrid 28041, Spain
| | - Guillermo DE Velasco
- Department of Medical Oncology, University Hospital October 12, Madrid 28041, Spain
| | - Daniel Castellano
- Department of Medical Oncology, University Hospital October 12, Madrid 28041, Spain
| | | | - Jordi Rodon
- Department of Medical Oncology, Vall d'Hebron University Hospital and The Autonomous University of Barcelona, Barcelona 08999, Spain
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30
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Hilario A, Sepulveda JM, Perez-Nuñez A, Salvador E, Millan JM, Hernandez-Lain A, Rodriguez-Gonzalez V, Lagares A, Ramos A. A prognostic model based on preoperative MRI predicts overall survival in patients with diffuse gliomas. AJNR Am J Neuroradiol 2014; 35:1096-102. [PMID: 24457819 PMCID: PMC7965146 DOI: 10.3174/ajnr.a3837] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/10/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffuse gliomas are classified as grades II-IV on the basis of histologic features, with prognosis determined mainly by clinical factors and histologic grade supported by molecular markers. Our aim was to evaluate, in patients with diffuse gliomas, the relationship of relative CBV and ADC values to overall survival. In addition, we also propose a prognostic model based on preoperative MR imaging findings that predicts survival independent of histopathology. MATERIALS AND METHODS We conducted a retrospective analysis of the preoperative diffusion and perfusion MR imaging in 126 histologically confirmed diffuse gliomas. Median relative CBV and ADC values were selected for quantitative analysis. Survival univariate analysis was made by constructing survival curves by using the Kaplan-Meier method and comparing subgroups by log-rank probability tests. A Cox regression model was made for multivariate analysis. RESULTS The study included 126 diffuse gliomas (median follow-up of 14.5 months). ADC and relative CBV values had a significant influence on overall survival. Median overall survival for patients with ADC < 0.799 × 10(-3) mm(2)/s was <1 year. Multivariate analysis revealed that patient age, relative CBV, and ADC values were associated with survival independent of pathology. The preoperative model provides greater ability to predict survival than that obtained by histologic grade alone. CONCLUSIONS ADC values had a better correlation with overall survival than relative CBV values. A preoperative prognostic model based on patient age, relative CBV, and ADC values predicted overall survival of patients with diffuse gliomas independent of pathology. This preoperative model provides a more accurate predictor of survival than histologic grade alone.
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Affiliation(s)
- A Hilario
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
| | | | - A Perez-Nuñez
- Neurosurgery (A.P.-N., A.L.), Hospital 12 de Octubre, Madrid, Spain
| | - E Salvador
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
| | - J M Millan
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
| | | | | | - A Lagares
- Neurosurgery (A.P.-N., A.L.), Hospital 12 de Octubre, Madrid, Spain
| | - A Ramos
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
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Delgado F, Saiz A, Hilario A, Murias E, San Román Manzanera L, Lagares Gomez-Abascal A, Gabarrós A, González García A. [Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques]. Radiologia 2013; 56:118-28. [PMID: 24144295 DOI: 10.1016/j.rx.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources.
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Affiliation(s)
- F Delgado
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Reina Sofia, Córdoba, España
| | - A Saiz
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Hilario
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital 12 de Octubre, Madrid, España
| | - E Murias
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - L San Román Manzanera
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Clinic, Barcelona, España
| | | | - A Gabarrós
- Servicio Neurocirugía, Hospital de Bellvitge, Barcelona, España
| | - A González García
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Abstract
Historically, brainstem gliomas have been considered as a single entity. Since the introduction of magnetic resonance (MR) imaging in the late 1980s, these tumors are now regarded as a heterogeneous group of neoplasms with different age of onset, clinical and radiologic presentation, and varying behavior and natural history. This article describes the different subtypes of brainstem gliomas in children and adults. We focus on recent advances in MR such as MR spectroscopy, MR perfusion, and diffusion tensor imaging that often strongly suggest the histopathologic diagnosis of the lesion.
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Affiliation(s)
- Ana Ramos
- Neuroradiology, Department of Radiology, Hospital 12 de Octubre, Madrid, Spain.
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Hilario A, Ramos A, Lagares A. Traumatic brain stem injury: evaluation by MRI. Author reply. AJNR Am J Neuroradiol 2013; 34:E57. [PMID: 23819159 DOI: 10.3174/ajnr.a3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hilario A, Ramos A, Millan JM, Salvador E, Gomez PA, Cicuendez M, Diez-Lobato R, Lagares A. Severe traumatic head injury: prognostic value of brain stem injuries detected at MRI. AJNR Am J Neuroradiol 2012; 33:1925-31. [PMID: 22576887 DOI: 10.3174/ajnr.a3092] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Traumatic brain injuries represent an important cause of death for young people. The main objectives of this work are to correlate brain stem injuries detected at MR imaging with outcome at 6 months in patients with severe TBI, and to determine which MR imaging findings could be related to a worse prognosis. MATERIALS AND METHODS One hundred and eight patients with severe TBI were studied by MR imaging in the first 30 days after trauma. Brain stem injury was categorized as anterior or posterior, hemorrhagic or nonhemorrhagic, and unilateral or bilateral. Outcome measures were GOSE and Barthel Index 6 months postinjury. The relationship between MR imaging findings of brain stem injuries, outcome, and disability was explored by univariate analysis. Prognostic capability of MR imaging findings was also explored by calculation of sensitivity, specificity, and area under the ROC curve for poor and good outcome. RESULTS Brain stem lesions were detected in 51 patients, of whom 66% showed a poor outcome, as expressed by the GOSE scale. Bilateral involvement was strongly associated with poor outcome (P < .05). Posterior location showed the best discriminatory capability in terms of outcome (OR 6.8, P < .05) and disability (OR 4.8, P < .01). The addition of nonhemorrhagic and anterior lesions or unilateral injuries showed the highest odds and best discriminatory capacity for good outcome. CONCLUSIONS The prognosis worsens in direct relationship to the extent of traumatic injury. Posterior and bilateral brain stem injuries detected at MR imaging are poor prognostic signs. Nonhemorrhagic injuries showed the highest positive predictive value for good outcome.
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Affiliation(s)
- A Hilario
- Department of Radiology, Hospital 12 de Octubre, Madrid, Spain.
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Cicuendez M, Paredes I, Munarriz PM, Hilario A, Cabello A, Lagares A. Primary melanoma of the cauda equina: Case report and review of the literature. Neurocirugia (Astur) 2012; 23:112-5. [PMID: 22561234 DOI: 10.1016/j.neucir.2012.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 02/02/2012] [Indexed: 02/07/2023]
Abstract
The authors report the case of an 82 year-old woman with a primary malignant melanoma of the cauda equina resembling lumbar schwannoma in the MRI study. Melanocytic neoplasms are very rare but they should be included in the differential diagnosis of lesions involving the spinal nerves. The treatment of choice for these lesions is complete resection followed by radiotherapy. The outcomes reported in the literature are variable and are associated with the age of presentation, histopathological findings, extent of surgical resection and absence of metastatic lesions.
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Affiliation(s)
- Marta Cicuendez
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
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Hilario A, Ramos A, Perez-Nuñez A, Salvador E, Millan JM, Lagares A, Sepulveda JM, Gonzalez-Leon P, Hernandez-Lain A, Ricoy JR. The added value of apparent diffusion coefficient to cerebral blood volume in the preoperative grading of diffuse gliomas. AJNR Am J Neuroradiol 2012; 33:701-7. [PMID: 22207304 PMCID: PMC8050428 DOI: 10.3174/ajnr.a2846] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/20/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In cerebral gliomas, rCBV correlates with tumor grade and histologic findings of vascular proliferation. Moreover, ADC assesses water diffusivity and is inversely correlated with tumor grade. In the present work, we have studied whether combined rCBV and ADC values improve the diagnostic accuracy of MR imaging in the preoperative grading of gliomas. MATERIALS AND METHODS One hundred sixty-two patients with histopathologically confirmed diffuse gliomas underwent DWI and DSC. Mean rCBV and ADC values were compared among the tumor groups with the Student t test or ANOVA. ROC analysis was used to determine rCBV and ADC threshold values for glioma grading. RESULTS rCBV had significantly different values between grade II and IV gliomas and between grade III and IV tumors, but there were no significant differences between grade II and III gliomas (P > .05). Grade II and III tumors also did not differ when astrocytomas, oligodendrogliomas, and oligoastrocytomas were considered separately. ADC values were significantly different for all 3 grades. The ADC threshold value of 1.185 × 10(-3) mm(2)/s and the rCBV cutoff value of 1.74 could be used with high sensitivity in the characterization of high-grade gliomas. The area under the ROC curve for the maximum rCBV and minimum ADC was 0.72 and 0.75, respectively. The combination of rCBV and ADC values increased the area under the ROC curve to 0.83. CONCLUSIONS ADC measurements are better than rCBV values for distinguishing the grades of gliomas. The combination of minimum ADC and maximum rCBV improves the diagnostic accuracy of glioma grading.
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Affiliation(s)
- A Hilario
- Department of Radiology, Hospital 12 de Octubre, Madrid, Spain.
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Fernández-Ruiz M, Villarejo A, Martínez-de-Aragón A, Hilario A. [Cerebral venous sinus thrombosis associated with Crohn's disease and protein C deficiency]. Rev Esp Enferm Dig 2010; 102:568-570. [PMID: 20883079 DOI: 10.4321/s1130-01082010000900014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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