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Parmar V, Haubold J, Salhöfer L, Meetschen M, Wrede K, Glas M, Guberina M, Blau T, Bos D, Kureishi A, Hosch R, Nensa F, Forsting M, Deuschl C, Umutlu L. Fully automated MR-based virtual biopsy of primary CNS lymphomas. Neurooncol Adv 2024; 6:vdae022. [PMID: 38516329 PMCID: PMC10956963 DOI: 10.1093/noajnl/vdae022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background Primary central nervous system lymphomas (PCNSL) pose a challenge as they may mimic gliomas on magnetic resonance imaging (MRI) imaging, compelling precise differentiation for appropriate treatment. This study focuses on developing an automated MRI-based workflow to distinguish between PCNSL and gliomas. Methods MRI examinations of 240 therapy-naive patients (141 males and 99 females, mean age: 55.16 years) with cerebral gliomas and PCNSLs (216 gliomas and 24 PCNSLs), each comprising a non-contrast T1-weighted, fluid-attenuated inversion recovery (FLAIR), and contrast-enhanced T1-weighted sequence were included in the study. HD-GLIO, a pre-trained segmentation network, was used to generate segmentations automatically. To validate the segmentation efficiency, 237 manual segmentations were prepared (213 gliomas and 24 PCNSLs). Subsequently, radiomics features were extracted following feature selection and training of an XGBoost algorithm for classification. Results The segmentation models for gliomas and PCNSLs achieved a mean Sørensen-Dice coefficient of 0.82 and 0.80 for whole tumors, respectively. Three classification models were developed in this study to differentiate gliomas from PCNSLs. The first model differentiated PCNSLs from gliomas, with an area under the curve (AUC) of 0.99 (F1-score: 0.75). The second model discriminated between high-grade gliomas and PCNSLs with an AUC of 0.91 (F1-score: 0.6), and the third model differentiated between low-grade gliomas and PCNSLs with an AUC of 0.95 (F1-score: 0.89). Conclusions This study serves as a pilot investigation presenting an automated virtual biopsy workflow that distinguishes PCNSLs from cerebral gliomas. Prior to clinical use, it is necessary to validate the results in a prospective multicenter setting with a larger number of PCNSL patients.
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Affiliation(s)
- Vicky Parmar
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Luca Salhöfer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Mathias Meetschen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Martin Glas
- Department of Neuropathology, University Hospital Essen, Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Tobias Blau
- Department of Neurology and Neurooncology, University Hospital Essen, Essen, Germany
| | - Denise Bos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Anisa Kureishi
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - René Hosch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Milosevic A, Styczen H, Haubold J, Kessler L, Grueneisen J, Li Y, Weber M, Fendler WP, Morawitz J, Damman P, Wrede K, Kebir S, Glas M, Guberina M, Blau T, Schaarschmidt BM, Deuschl C. Correlation of the apparent diffusion coefficient with the standardized uptake value in meningioma of the skull plane using [68]Ga-DOTATOC PET/MRI. Nucl Med Commun 2023; 44:1106-1113. [PMID: 37823259 DOI: 10.1097/mnm.0000000000001774] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 10/13/2023]
Abstract
PURPOSE To evaluate a correlation between an MRI-specific marker for cellular density [apparent diffusion coefficient (ADC)] and the expression of Somatostatin Receptors (SSTR) in patients with meningioma of the skull plane and orbital space. METHODS 68 Ga-DOTATOC PET/MR imaging was performed in 60 Patients with suspected or diagnosed meningiomas of the skull base and eye socket. Analysis of ADC values succeeded in 32 patients. ADC values (ADC mean and ADC min ) were analyzed using a polygonal region of interest. Tracer-uptake of target lesions was assessed according to corresponding maximal (SUV max ) and mean (SUV mean ) values. Correlations between assessed parameters were evaluated using the Pearson correlation coefficient. RESULTS One out of 32 patients (3%) was diagnosed with lymphoma by histopathological examination and therefore excluded from further analysis. Median ADC mean amounted to 822 × 10 -5 mm²/s -1 (95% CI: 570-1497) and median ADC min was 493 × 10 -5 mm 2 /s -1 (95% CI: 162-783). There were no significant correlations between SUV max and ADC min (r = 0.60; P = 0.76) or ADC mean (r = -0.52; P = 0.79), respectively. However, Pearson's test showed a weak, inverse but insignificant correlation between ADC mean and SUV mean (r = -0.33; P = 0.07). CONCLUSION The presented data displays no relevant correlations between increased SSTR expression and cellularity in patients with meningioma of the skull base. SSTR-PET and DWI thus may offer complementary information on tumor characteristics of meningioma.
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Affiliation(s)
- Aleksandar Milosevic
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
| | - Hanna Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
| | - Lukas Kessler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
| | - Johannes Grueneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen,
| | | | | | - Philipp Damman
- Department of Neurosurgery and Spine Surgery, University Hospital Essen,
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen,
| | - Sied Kebir
- Department of Neurology and Neurooncology, University Hospital Essen,
| | - Martin Glas
- Department of Neurology and Neurooncology, University Hospital Essen,
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen and
| | - Tobias Blau
- Department of Neuropathology, University Hospital Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen,
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Milosevic A, Styczen H, Grueneisen J, Li Y, Weber M, Fendler WP, Kirchner J, Damman P, Wrede K, Lazaridis L, Glas M, Guberina M, Eckstein A, Blau T, Herrmann K, Umutlu L, Forsting M, Deuschl C, Schaarschmidt B. Evaluation of [ 68Ga]-DOTATOC PET/MRI in Patients with Meningioma of the Subcranial and Intraorbital Space. J Nucl Med 2023:jnumed.123.265424. [PMID: 37385668 DOI: 10.2967/jnumed.123.265424] [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: 01/09/2023] [Revised: 04/20/2023] [Indexed: 07/01/2023] Open
Abstract
Meningiomas are known to express somatostatin receptor (SSTR) type 2 to a high degree. Therefore, radiolabeled somatostatin analogs, such as DOTATOC, have been introduced for PET imaging of meningiomas. However, the benefit of hybrid SSTR PET/MRI is still debated. Here, we report our experience with [68Ga]-DOTATOC PET/MRI. Methods: PET/MRI was performed in 60 patients with suspected or diagnosed meningiomas of the skull plane and eye socket. Acquired datasets were reported by 2 independent readers regarding local tumor extent and signal characteristics. Histopathologic results and follow-up imaging served as the reference standard. SUVs of target lesions were analyzed according to the corresponding maximal tracer uptake. The diagnostic accuracy of PET/MRI and conventional MRI was determined independently and compared with the reference standard. Results: In total, 60 target lesions were identified, with 54 considered to be meningiomas according to the reference standard. Sensitivity and specificity of PET/MRI versus MRI alone were 95% versus 96% and 75% versus 66%, respectively. The McNemar test was not able to distinguish any differences between PET/MRI and the reference standard or MRI and the reference standard. No differences were found between the 2 modalities with respect to local infiltration. Conclusion: SSTR PET/MRI and MRI yielded similar accuracy for the detection of meningiomas of the skull base and intraorbital space. Here, sequential low-dose SSTR PET/CT might be helpful for the planning of radioligand therapy or radiotherapy.
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Affiliation(s)
- Aleksandar Milosevic
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany;
| | - Hanna Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Johannes Grueneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Julian Kirchner
- Institute of Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Philipp Damman
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Düsseldorf, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Düsseldorf, Germany
| | - Lazaros Lazaridis
- Department of Neurology and Neurooncology, University Hospital Essen, Düsseldorf, Germany
| | - Martin Glas
- Department of Neurology and Neurooncology, University Hospital Essen, Düsseldorf, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, Düsseldorf, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Düsseldorf, Germany; and
| | - Tobias Blau
- Department of Neuropathology, University Hospital Essen, Düsseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Düsseldorf, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
| | - Benedikt Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Düsseldorf, Germany
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Alatzides GL, Opitz M, Li Y, Goericke S, Oppong MD, Frank B, Eckstein AK, Köhrmann M, Wrede K, Forsting M, Wanke I, Deuschl C. Management of carotid cavernous fistulas: A single center experience. Front Neurol 2023; 14:1123139. [PMID: 36846124 PMCID: PMC9947522 DOI: 10.3389/fneur.2023.1123139] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose Multimodal endovascular therapy (EVT) of carotid cavernous fistula (CCF) with different approaches and a variety of available embolization material enable high occlusion rates with good clinical and functional outcome but until now there is still little evidence available. This retrospective single-center study aims to evaluate EVT of CCF with different neuroendovascular techniques regarding occlusion rates, complications and outcomes. Materials and methods From 2001 to 2021 59 patients with CCF were treated at our tertiary university hospital. Patient records and all imaging data including angiograms were reviewed for demographic and epidemiological data, symptoms, fistula type, number of EVTs, complications of EVT, type of embolic materials, occlusion rates and recurrences. Results Etiology of the CCF were spontaneous (41/59, 69.5%) post-traumatic (13/59, 22%) and ruptured cavernous aneurysms (5/59, 8.5%). Endovascular therapy was completed in one session in 74.6% (44/59). Transvenous access was most frequent (55.9% 33/59) followed by transarterial catheterization in 33.9% (20/59) and a combination of both (6/59, 10.2%). Exclusively coils were used in 45.8% (27/59), a combination of ethylene vinyl alcohol (EVOH) copolymer (Onyx) and coils in 42.4% (25/59). Complete obliteration was achieved in 96.6% of patients (57/59) with an intraprocedural-related complication rate of 5.1% (3/59) and no mortality. Conclusion Endovascular therapy of CCF has been shown to be safe and effective with high cure rates and low rates of intraprocedural complications and morbidity even in complex scenarios.
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Affiliation(s)
- Georgios Luca Alatzides
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany,*Correspondence: Georgios Luca Alatzides ✉
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Sophia Goericke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, Essen University Hospital, Essen, Germany
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Essen, Germany
| | | | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, Essen University Hospital, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany,Department of Neuroradiology, Klinik Hirslanden and Swiss Neuro Radiology Institute, Zurich, Switzerland
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
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Grzywotz A, Li Y, Unger N, Kiewert C, Chmielewski WX, Sure U, Uerschels A, Wrede K, Kreitschmann-Andermahr I. Pituitary enlargement in patients with cerebrospinal fluid drainage due to ventricular shunt insertion: know the condition and do not mistake for adenoma. Pituitary 2023; 26:164-170. [PMID: 36652088 PMCID: PMC9908659 DOI: 10.1007/s11102-022-01296-y] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Childhood hydrocephalus patients treated by ventriculo-peritoneal (v.-p.) shunting are sometimes referred years after this therapy for evaluation of suspicious pituitary enlargement. Since pituitary size has been shown to depend on cerebrospinal fluid (CSF) pressure, we assume this phenomenon to be caused by shunt overdrainage. Therefore, we studied pituitary size and morphology in shunted hydrocephalus patients with radiological signs of high CSF drainage. PATIENTS AND METHODS Retrospective study of pituitary size and morphology in 15 shunted patients with non-tumoral hydrocephalus and 7 shunted hydrocephalus patients due to childhood brain tumor compared to a population mean. In five brain tumor patients also pre- and postsurgical comparisons were performed. RESULTS Pituitary mid-sagittal size and pituitary volume were significantly higher in both hydrocephalus groups, compared to the population mean (midsagittal size t = 5.91; p < 0.001; pituitary volume, t = 3.03; p = 0.006). In patients available for pre- and postoperative comparison, there was also a significant increase in pituitary size and volume postoperatively (mean preoperative midsagittal height 2.54 ± 1.0 mm vs. 6.6 ± 0.7 mm post-surgery; mean pre-operative pituitary volume 120.5 ± 69.2 mm3 vs. 368.9 ± 57.9 mm3 post-surgery). CONCLUSION Our results confirmed a significant increase in pituitary size and volume, mimicking pituitary pathology, after v.-p. shunt insertion. This phenomenon can be explained by the Monro-Kellie doctrine, stating that intracranial depletion of CSF-as caused by v.p. shunting-leads to compensatory intracranial hyperemia, especially in the venous system, with the consequence of engorged venous sinuses, most likely responsible for enlargement of the pituitary gland.
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Affiliation(s)
- Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Yan Li
- Institute of Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Cordula Kiewert
- Department of Pediatric Endocrinology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Witold X Chmielewski
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Anne Uerschels
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Altenbernd JC, Fischer S, Scharbrodt W, Schimrigk S, Eyding J, Nordmeyer H, Wohlert C, Dörner N, Li Y, Wrede K, Pierscianek D, Köhrmann M, Frank B, Forsting M, Deuschl C. CT and DSA for evaluation of spontaneous intracerebral lobar bleedings. Front Neurol 2022; 13:956888. [PMID: 36262835 PMCID: PMC9574012 DOI: 10.3389/fneur.2022.956888] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose This study retrospectively examined the extent to which computed tomography angiography (CTA) and digital subtraction angiography (DSA) can help identify the cause of lobar intracerebral bleeding. Materials and methods In the period from 2002 to 2020, data from patients who were >18 years at a university and an academic teaching hospital with lobar intracerebral bleeding were evaluated retrospectively. The CTA DSA data were reviewed separately by two neuroradiologists, and differences in opinion were resolved by consensus after discussion. A positive finding was defined as an underlying vascular etiology of lobar bleeding. Results The data of 412 patients were retrospectively investigated. DSA detected a macrovascular cause of bleeding in 125/412 patients (33%). In total, sixty patients had AVMs (15%), 30 patients with aneurysms (7%), 12 patients with vasculitis (3%), and 23 patients with dural fistulas (6%). The sensitivity, specificity, positive and negative predictive values, and accuracy of CTA compared with DSA were 93, 97, 100, and 97%. There were false-negative CTA readings for two AVMs and one dural fistula. Conclusion The DSA is still the gold standard diagnostic modality for detecting macrovascular causes of ICH; however, most patients with lobar ICH can be investigated first with CTA, and the cause of bleeding can be found. Our results showed higher sensitivity and specificity than those of other CTA studies.
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Affiliation(s)
- Jens-Christian Altenbernd
- Department of Radiology, Gemeinschaftskrankenhaus, Herdecke, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- *Correspondence: Jens-Christian Altenbernd
| | | | | | | | - Jens Eyding
- Department of Neurology, Gemeinschaftskrankenhaus, Herdecke, Germany
| | | | - Christine Wohlert
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nils Dörner
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | | | - Martin Köhrmann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Benedikt Frank
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Zhu Y, Chen Z, Kim SN, Gan C, Ryl T, Lesjak MS, Rodemerk J, Zhong RD, Wrede K, Dammann P, Sure U. Characterization of Temozolomide Resistance Using a Novel Acquired Resistance Model in Glioblastoma Cell Lines. Cancers (Basel) 2022; 14:cancers14092211. [PMID: 35565340 PMCID: PMC9101568 DOI: 10.3390/cancers14092211] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Temozolomide (TMZ) is the first-line drug for chemotherapy of GBM, the most aggressive and incurable brain tumor. Acquired chemoresistance is a hallmark that causes the poor prognosis of GBM. Therefore, understanding the underlying mechanisms by using a proper model becomes emergent. Previous models usually take weeks/months and are often not fully representative of characteristics of TMZ resistance. We established an acute acquired TMZ resistance model using GBM cell lines with different genomic backgrounds. In response to TMZ, the resistant cells showed less susceptibility and sustained regrowth, high clonogenicity, reduced DNA damage accompanied by attenuated MMR, shortened G2/M arrest, uncontrolled DNA replication, and evasion of apoptosis. Moreover, these TMZ resistant cells presented stem cell properties that are critical for chemoresistance. Thus, our model recapitulates all key features of TMZ resistance and is believed to be a promising model to study the underlying mechanisms and define therapeutics for GBM in the future. Abstract Temozolomide (TMZ) is the first line of standard therapy in glioblastoma (GBM). However, relapse occurs due to TMZ resistance. We attempted to establish an acquired TMZ resistance model that recapitulates the TMZ resistance phenotype and the relevant gene signature. Two GBM cell lines received two cycles of TMZ (150 µM) treatment for 72 h each. Regrown cells (RG2) were defined as TMZ resistant cells. MTT assay revealed significantly less susceptibility and sustained growth of RG2 compared with parental cells after TMZ challenge. TMZ-induced DNA damage significantly decreased in 53BP1-foci reporter transduced-RG2 cells compared with parental cells, associated with downregulation of MSH2 and MSH6. Flow cytometry revealed reduced G2/M arrest, increased EdU incorporation and suppressed apoptosis in RG2 cells after TMZ treatment. Colony formation and neurosphere assay demonstrated enhanced clonogenicity and neurosphere formation capacity in RG2 cells, accompanied by upregulation of stem markers. Collectively, we established an acute TMZ resistance model that recapitulated key features of TMZ resistance involving impaired mismatch repair, redistribution of cell cycle phases, increased DNA replication, reduced apoptosis and enhanced self-renewal. Therefore, this model may serve as a promising research tool for studying mechanisms of TMZ resistance and for defining therapeutic approaches to GBM in the future.
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Affiliation(s)
- Yuan Zhu
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence: ; Tel.: +0049-201-723-1231
| | - Zhen Chen
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
| | - Su Na Kim
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
| | - Chao Gan
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
| | - Tatsiana Ryl
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
| | - Michaela Silvia Lesjak
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
| | - Jan Rodemerk
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
| | - Rong De Zhong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (Z.C.); (S.N.K.); (C.G.); (T.R.); (M.S.L.); (J.R.); (R.D.Z.); (K.W.); (P.D.); (U.S.)
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
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Parlak A, Oppong MD, Jabbarli R, Gembruch O, Dammann P, Wrede K, Rauschenbach L, Sure U, Özkan N. Do Tumour Size, Type and Localisation Affect Resection Rate in Patients with Spinal Schwannoma? Medicina (B Aires) 2022; 58:medicina58030357. [PMID: 35334533 PMCID: PMC8950654 DOI: 10.3390/medicina58030357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Spinal schwannomas are benign tumours that can present with various symptoms such as pain, radiculopathy and neurological deficit. Gross total resection (GTR) is of key importance for local recurrence. The aim of this study is to describe the clinical characteristics, resection rate, clinical outcome, as well as tumour recurrence, in patients with non-syndromic spinal schwannomas and to clarify which factors affect the resection rate. Materials and Methods: Patients with non-syndromic spinal schwannomas that underwent surgical resection between January 2009 and December 2018 at a single institution were included. Demographic parameters, clinical symptoms, tumour localisation and size, surgical approach and complications were noted. Factors influencing the extent of resection, the surgeon’s decision regarding the approach and the occurrence of new postoperative deficits were evaluated. Results: Fifty patients (18 females) were included. The most common presenting symptom was radiculopathy (88%). The lumbar spine was the most commonly affected site (58%). Laminotomy (72%) was the preferred surgical approach overall and specifically for exclusively intraspinal schwannomas (p = 0.02). GTR was achieved in 76.0% (n = 38). In multivariate analysis, only tumour localisation within the spinal canal (p = 0.014) independently predicted GTR, whereas the type of approach (p = 0.50) and tumour volume (p = 0.072) did not. New postoperative persisting deficits could not be predicted by any factor, including the use and alteration of intraoperative neuromonitoring. Recurrence was observed in four cases (8%) and was significantly higher in cases with STR (p = 0.04). Conclusions: In this retrospective study, GTR was solely predicted by tumour localisation within the spinal canal. The decision regarding the utilisation of different surgical approaches was solely influenced by the same factor. No factor could predict new persisting deficits. Tumour recurrence was higher in STR.
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Affiliation(s)
- Ahmet Parlak
- Correspondence: ; Tel.: +49-201-723-1201; Fax: +49-201-723-5909
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9
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Li Y, van Landeghem N, Demircioglu A, Köhrmann M, Kellner E, Milles L, Stolte B, Totzeck A, Dammann P, Wrede K, Theysohn JM, Styczen H, Forsting M, Wanke I, Frank B, Deuschl C. Predictors of Early Neurological Improvement in Patients with Anterior Large Vessel Occlusion and Successful Reperfusion Following Endovascular Thrombectomy-Does CT Perfusion Imaging Matter? Clin Neuroradiol 2022; 32:839-847. [PMID: 35244728 PMCID: PMC9424155 DOI: 10.1007/s00062-022-01147-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/30/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE We aimed to investigate treatment effect of endovascular thrombectomy (EVT) on the change of National Institutes of Health Stroke Scale (NIHSS) scores in acute ischemic stroke (AIS) patients with anterior large vessel occlusion (LVO). Predictors of early neurological improvement (ENI) were assessed in those with successful reperfusion. METHODS Data on stroke patients from January 2018 to December 2020 were retrospectively analyzed. Anterior LVO was defined as occlusion of internal carotid artery and/or M1/M2 branch of middle cerebral artery. A reduction of at least 8 NIHSS points at 24 h after EVT or NIHSS score ≤ 1 at discharge was defined as ENI. In patients with successful reperfusion (TICI score of 2b/3) and available CT perfusion (CTP) imaging, 20 variables were tested in a smoothed ridge regression for their association with ENI. RESULTS One hundred seventy two out of 211 patients had successful perfusion with 54 patients achieving ENI. Impact of successful EVT on reducing NIHSS score grew continuously on a daily basis up to the date of discharge. 105 out of 172 patients were included in final regression model. Short time from onset to admission and from groin-puncture to reperfusion, young age, low prestroke disability, high baseline CTP ASPECTS and high follow-up non-contrast CT (NCCT) ASPECTS were significantly associated with ENI. Neither baseline NCCT ASPECTS nor the volume of penumbra or ischemic core measured on CTP were associated with ENI. CONCLUSION CTP ASPECTS might better predict ENI than non-contrast CT at baseline in patients with successful reperfusion following EVT.
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Affiliation(s)
- Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Natalie van Landeghem
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Aydin Demircioglu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, University Medical Center Freiburg, Killianstraße 5a, 79106, Freiburg, Germany
| | - Lennart Milles
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Benjamin Stolte
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Andreas Totzeck
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Jens Matthias Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Hanna Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
- Swiss Neuroradiology Institute, Bürglistraße 29, 8002, Zurich, Switzerland
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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Santos AN, Rauschenbach L, Darkwah Oppong M, Gembruch O, Saban D, Chen B, Herten A, Schmidt B, Li Y, Özkan N, Jabbarli R, Wrede K, Sure U, Dammann P. Natural course of untreated spinal cord cavernous malformations: a follow-up study within the initial 5 years after diagnosis. J Neurosurg Spine 2021:1-5. [PMID: 34920423 DOI: 10.3171/2021.9.spine211052] [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: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cavernous spinal cord malformations (SCMs) are believed to have a high rate of bleeding. The risk of intramedullary hemorrhage (IMH) or recurrent IMH and the neurological impact of bleeding events are important for clinical decision-making and could impact current treatment strategies. METHODS The authors screened their institutional database for patients with cavernous SCM treated between 2003 and 2020. Patients with complete MRI data sets and clinical baseline characteristics were included. Surgically treated patients were censored after cavernous SCM removal. Neurological functional status was obtained using the modified McCormick (MMcC) scale at diagnosis, first IMH, and second IMH. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative 5-year risk for hemorrhage or rehemorrhage. RESULTS Seventy-one patients with cavernous SCM were analyzed. Cox regression analysis identified previous IMH (hazard ratio 7.86, 95% confidence interval 1.01-61.47, p = 0.049) as an independent predictor for rehemorrhage during the 5-year follow-up. The cumulative 5-year risk of bleeding or rebleeding was 41.3% for cavernous SCM. The MMcC score significantly deteriorated in 75% of patients after recurrent hemorrhage (p = 0.012). CONCLUSIONS During untreated 5-year follow-up, a considerably increased risk for hemorrhage or rehemorrhage was found in cavernous malformations of the spinal cord compared to cerebral cavernous malformations. Neurological function significantly deteriorates after the second bleeding. The probability of recurrent IMH increased significantly after initial presentation with hemorrhage.
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Affiliation(s)
| | | | | | | | - Dino Saban
- 1Department of Neurosurgery and Spine Surgery
| | - Bixia Chen
- 1Department of Neurosurgery and Spine Surgery
| | | | - Börge Schmidt
- 2Institute for Medical Informatics, Biometry, and Epidemiology, and
| | - Yan Li
- 3Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | | | | | | | - Ulrich Sure
- 1Department of Neurosurgery and Spine Surgery
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Haubold J, Hosch R, Parmar V, Glas M, Guberina N, Catalano OA, Pierscianek D, Wrede K, Deuschl C, Forsting M, Nensa F, Flaschel N, Umutlu L. Fully Automated MR Based Virtual Biopsy of Cerebral Gliomas. Cancers (Basel) 2021; 13:cancers13246186. [PMID: 34944806 PMCID: PMC8699054 DOI: 10.3390/cancers13246186] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the diagnostic accuracy of a radiomics analysis based on a fully automated segmentation and a simplified and robust MR imaging protocol to provide a comprehensive analysis of the genetic profile and grading of cerebral gliomas for everyday clinical use. METHODS MRI examinations of 217 therapy-naïve patients with cerebral gliomas, each comprising a non-contrast T1-weighted, FLAIR and contrast-enhanced T1-weighted sequence, were included in the study. In addition, clinical and laboratory parameters were incorporated into the analysis. The BraTS 2019 pretrained DeepMedic network was used for automated segmentation. The segmentations generated by DeepMedic were evaluated with 200 manual segmentations with a DICE score of 0.8082 ± 0.1321. Subsequently, the radiomics signatures were utilized to predict the genetic profile of ATRX, IDH1/2, MGMT and 1p19q co-deletion, as well as differentiating low-grade glioma from high-grade glioma. RESULTS The network provided an AUC (validation/test) for the differentiation between low-grade gliomas vs. high-grade gliomas of 0.981 ± 0.015/0.885 ± 0.02. The best results were achieved for the prediction of the ATRX expression loss with AUCs of 0.979 ± 0.028/0.923 ± 0.045, followed by 0.929 ± 0.042/0.861 ± 0.023 for the prediction of IDH1/2. The prediction of 1p19q and MGMT achieved moderate results, with AUCs of 0.999 ± 0.005/0.711 ± 0.128 for 1p19q and 0.854 ± 0.046/0.742 ± 0.050 for MGMT. CONCLUSION This fully automated approach utilizing simplified MR protocols to predict the genetic profile and grading of cerebral gliomas provides an easy and efficient method for non-invasive tumor decoding.
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Affiliation(s)
- Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
- Correspondence: ; Tel.: +49-201-723-84528; Fax: +49-201-723-1548
| | - René Hosch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
| | - Vicky Parmar
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
| | - Martin Glas
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, D-45147 Essen, Germany;
| | - Nika Guberina
- Department of Radiotherapy, University Hospital Essen, D-45147 Essen, Germany;
| | - Onofrio Antonio Catalano
- Department of Radiology, Division of Abdominal Imaging, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, Boston 02114, MA, USA;
| | - Daniela Pierscianek
- Department of Neurosurgery, University Hospital Essen, D-45147 Essen, Germany; (D.P.); (K.W.)
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, D-45147 Essen, Germany; (D.P.); (K.W.)
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
| | - Nils Flaschel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany; (R.H.); (V.P.); (C.D.); (M.F.); (F.N.); (N.F.); (L.U.)
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12
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Herten A, Saban D, Santos AN, Chen B, Darkwah Oppong M, Rauschenbach L, Jabbarli R, Wrede K, Bingel U, Müller D, Holle-Lee D, Schmidt B, Li Y, Sure U, Dammann P. The occurrence of neuropathic pain following surgery of brainstem cavernous malformations. Eur J Neurol 2021; 29:865-872. [PMID: 34762327 DOI: 10.1111/ene.15179] [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: 06/11/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to assess the occurrence and significance of postoperative neuropathic pain (NP) in patients with surgically treated brainstem cavernous malformations (BSCMs). METHODS Seventy-four BSCM patients surgically treated between 2003 and 2019 were reviewed for the occurrence of postoperative NP and related treatment. The relevance of BSCM location, preoperative characteristics, influence on functional outcome, postoperative health-related quality of life (HRQOL) and life satisfaction was evaluated. RESULTS Six out of 74 patients (8%) suffered from NP. The Leeds Assessment of Neuropathic Symptoms and Signs scores ranged from 12 to 16 (mean 14.28 ± 1.6). Visual analog scale pain was 5.2 ± 2.0. NP had no effect on preoperative characteristics or functional outcome. Bodily pain (HRQOL) and vocational time (life satisfaction) were significantly decreased in NP compared to non-NP patients. Specific BSCM location (regarding brainstem nuclei involved in pain processing) and other preoperative patient- and BSCM-related parameters were not associated with the occurrence of postoperative NP. Three out of six patients were currently under NP-specific treatment. The proportion of patients suffering from postoperative NP (8%) was substantially higher compared to previously published studies. The pain affected the HRQOL of patients, most of whom were insufficiently treated and not satisfied with treatment results. CONCLUSION Our findings may help to raise awareness for postoperative NP in BSCM, which is essential to improve diagnosis and initiation of proper treatment, as well as preoperative informed consent of patients.
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Affiliation(s)
- Annika Herten
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Dino Saban
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Alejandro N Santos
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Bixia Chen
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Laurèl Rauschenbach
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Daniel Müller
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Dagny Holle-Lee
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- ¹Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
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13
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Dammann P, Saban DV, Herten A, Chen B, Zhu Y, Santos A, Rauschenbach L, Wrede K, Jabbarli R, Schmidt B, Jöckel KH, Kleinschnitz C, Forsting M, Sure U. Cerebral cavernous malformations: Prevalence of cardiovascular comorbidities and allergic diseases compared to the normal population. Eur J Neurol 2021; 28:2000-2005. [PMID: 33738912 DOI: 10.1111/ene.14833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To determine the prevalence of cardiovascular comorbidities and allergic diseases in patients with cavernous malformations of the central nervous system compared to the normal population. METHODS Clinical and magnetic resonance imaging data of 1352 patients with cerebral cavernous malformations (CCM) from an observational, cross-sectional, single-institutional study were analyzed and compared to an age-and-gender stratified and matched sample from a population-based, epidemiological study assessing cardiovascular risk factors in the local normal population of the same area (RECALL study). RESULTS Of 1352 patients, 810 (60%) were female. Mean age was 40.4 ± 16 years. 221 patients (16%) suffered from familial disease. Presence of cardiovascular risk factors and intake of certain drugs in the overall cohort was mostly equal to the normal population reference sample (n = 786). The prevalence of allergic diseases was found to be significantly higher in all CCM patients compared to the normal population (30% vs. 20%, odds ratio [OR] 1.35 [1.12-1.63]) and in sporadic CCM cases compared to the normal population and familial cases (32% vs. 20% (OR 1.46 [1.19-1.78], p = 0.0001) and 22% vs. 20%, respectively). CONCLUSIONS We present novel data on CCM using a large single-institution and population-based setup. The study elaborates disease characteristics of CCM patients in detail. For the first time, evidence for an unexplained high prevalence of allergic diseases in this patient population is described (differing between sporadic and familial cases), supporting the hypothesis that immune response is involved in the pathogenesis of CCM.
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Affiliation(s)
- Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Dino Vitali Saban
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Annika Herten
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Bixia Chen
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Yuan Zhu
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Alejandro Santos
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | | | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
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14
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Wessels L, Fekonja LS, Achberger J, Dengler J, Czabanka M, Hecht N, Schneider U, Tkatschenko D, Schebesch KM, Schmidt NO, Mielke D, Hosch H, Ganslandt O, Gräwe A, Hong B, Walter J, Güresir E, Bijlenga P, Haemmerli J, Maldaner N, Marbacher S, Nurminen V, Zitek H, Dammers R, Kato N, Linfante I, Pedro MT, Wrede K, Wang WT, Wostrack M, Vajkoczy P. Diagnostic reliability of the Berlin classification for complex MCA aneurysms-usability in a series of only giant aneurysms. Acta Neurochir (Wien) 2020; 162:2753-2758. [PMID: 32929543 PMCID: PMC7550378 DOI: 10.1007/s00701-020-04565-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
Background and objective The main challenge of bypass surgery of complex MCA aneurysms is not the selection of the bypass type but the initial decision-making of how to exclude the affected vessel segment from circulation. To this end, we have previously proposed a classification for complex MCA aneurysms based on the preoperative angiography. The current study aimed to validate this new classification and assess its diagnostic reliability using the giant aneurysm registry as an independent data set. Methods We reviewed the pretreatment neuroimaging of 51 patients with giant (> 2.5 cm) MCA aneurysms from 18 centers, prospectively entered into the international giant aneurysm registry. We classified the aneurysms according to our previously proposed Berlin classification for complex MCA aneurysms. To test for interrater diagnostic reliability, the data set was reviewed by four independent observers. Results We were able to classify all 51 aneurysms according to the Berlin classification for complex MCA aneurysms. Eight percent of the aneurysm were classified as type 1a, 14% as type 1b, 14% as type 2a, 24% as type 2b, 33% as type 2c, and 8% as type 3. The interrater reliability was moderate with Fleiss’s Kappa of 0.419. Conclusion The recently published Berlin classification for complex MCA aneurysms showed diagnostic reliability, independent of the observer when applied to the MCA aneurysms of the international giant aneurysm registry.
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Affiliation(s)
- Lars Wessels
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lucius Samo Fekonja
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Johannes Achberger
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Julius Dengler
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurosurgery, Helios Clinic, Bad Saarow, Germany
- Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Germany
| | - Marcus Czabanka
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ulf Schneider
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dimitri Tkatschenko
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Nils Ole Schmidt
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-University Goettingen, Göttingen, Germany
| | - Henning Hosch
- Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | - Alexander Gräwe
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Germany
| | - Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Jan Walter
- Department of Neurosurgery, University Hospital Jena, Jena, Germany
- Department of Neurosurgery, Medical Center Saarbrücken, Saarbrücken, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Philippe Bijlenga
- Service de Neurochirurgie, Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève, Geneva, Switzerland
| | - Julien Haemmerli
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Service de Neurochirurgie, Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève, Geneva, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich, Zürich, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Ville Nurminen
- Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hynek Zitek
- Department of Neurosurgery, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Ruben Dammers
- Erasmus Stroke Center, Erasmus MC University Hospital, Rotterdam, The Netherlands
| | - Naoki Kato
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Italo Linfante
- Interventional Neuroradiology and Endovascular Neurosurgery at Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, Miami, USA
| | | | - Karsten Wrede
- Department of Neurosurgery, University of Essen, Duisburg, Germany
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University, Vienna, Austria
| | - Maria Wostrack
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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15
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Herten A, Chen B, Saban D, Santos A, Wrede K, Jabbarli R, Zhu Y, Schmidt B, Kleinschnitz C, Forsting M, Sure U, Dammann P. Health-related quality of life in patients with untreated cavernous malformations of the central nervous system. Eur J Neurol 2020; 28:491-499. [PMID: 32961598 DOI: 10.1111/ene.14546] [Citation(s) in RCA: 6] [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: 06/11/2020] [Accepted: 09/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE To estimate health-related quality of life (HRQOL) in patients with untreated cavernous malformation of the CNS [cavernous cerebral malformations (CCMs)]. METHODS We performed a cross-sectional observational study on patients with CCMs admitted to our department from 1 November 2017 to 10 January 2020 using standardized interviews [short-form-36 questionnaire, hospital anxiety and depression score (HADS-A/D), CCM perception questionnaire]. Included criteria were diagnosis of an untreated CCM and information about the diagnosis in a specialized CCM consultation. Health-related quality of life (HRQOL) data were analyzed and compared to the German normal population. Uni- and multivariate analyses were carried out to identify variables with impact on outcome. RESULTS Two hundred nineteen (93%) of 229 eligible patients were included. Mean age was 46.3 ± 14.7 (18-86) years; 136 (62%) were female. Ninety-eight (45%) patients presented with symptomatic hemorrhage (SH), and 17 (8%) with repetitive SH. Ninety-two (42%) patients were asymptomatic. Thirty-seven patients (17%) suffered from cavernoma-related epilepsy. Twenty-eight patients (13%) suffered from familial CCMs. Patients showed significantly decreased component scores and subdomain scores compared to the normal population, with effects ranging from small to large. This accounted largely also for asymptomatic patients (except for physical component score and main physical subdomains). Multivariate regression analysis confirmed impact of functional impairment on physical component score. HADS-A was significantly increased. HADS-A/D strongly correlated with mental component score and individual perception of the CCM. CONCLUSIONS Patients with the diagnosis of a CCM showed decreased HRQOL compared to the normal population even when not suffering functional impairment or neurological symptoms. Our data may function as benchmarks in evaluation of different (future) management strategies.
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Affiliation(s)
- A Herten
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - B Chen
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - D Saban
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - A Santos
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - K Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - R Jabbarli
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Y Zhu
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - B Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - C Kleinschnitz
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - U Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - P Dammann
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
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16
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Deuschl C, Darkwah Oppong M, Styczen H, Markhardt L, Wrede K, Jabbarli R, Sure U, Radbruch A, Forsting M, Wanke I, Mönninghoff C. Therapy results of pericallosal aneurysms: A retrospective unicenter study. Clin Pract 2020; 10:1257. [PMID: 33014320 PMCID: PMC7512184 DOI: 10.4081/cp.2020.1257] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/30/2020] [Indexed: 12/27/2022] Open
Abstract
This retrospective study aims to compare treatment results of ruptured and unruptured pericallosal artery aneurysms (PAAs) regarding patient outcome and aneurysm recurrence after endovascular treatment (EVT) and neurosurgical treatment (NT). A total of 67 patients with PAA were admitted to our hospital, 44 patients with subarachnoidal hemorrhage (SAH) due to a ruptured PAA and 23 patients with unruptured PAA. The radiographic features of PAA were collected from pre-treatment digital subtraction angiography. In addition, demographic, clinical and radiographic parameters of all patients were recorded. Outcome was measured based on the modified Rankin scale (mRS) at 6 months after admission (favorable mRS score, 0-2 vs unfavorable mRS score, 3-6). Overall 46 patients underwent EVT and 21 patients NT. Six months after discharge 24 patients with SAH had a favorable outcome (mRS 0-2) and 16 patients an unfavorable outcome (mRS 3-6). Mortality rate of patients with SAH was 9.1% (4/44). Overall aneurysm recurrence was treated in 13 % of patients in the EVT cohort (6/46), whereas patients treated with NT had no recurrence. All patients with unruptured PAA had a favorable outcome. EVT and NT of PAA show comparable good results, although aneurysm recurrence occurs more often after EVT.
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Affiliation(s)
- Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lisa Markhardt
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Clinic for Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Clinic for Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Clinic for Neurosurgery, University Hospital Essen, Essen, Germany
| | - Alexander Radbruch
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Isabel Wanke
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Center for Neuroradiology, Clinic Hirslanden, Zurich, Switzerland
| | - Christoph Mönninghoff
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Clinic for Neuroradiology, Clemenshospital Muenster, Germany
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17
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Sinnecker T, Hadisurya J, Schneider-Hohendorf T, Schwab N, Wrede K, Gembruch O, Gold R, Hellwig K, Pilgram-Pastor S, Adams O, Albrecht P, Hartung HP, Aktas O, Kraemer M. Extensive immune reconstitution inflammatory syndrome in Fingolimod-associated PML: a case report with 7 Tesla MRI data. BMC Neurol 2019; 19:190. [PMID: 31399069 PMCID: PMC6688281 DOI: 10.1186/s12883-019-1407-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Progressive multifocal leukoencephalopathy (PML) is a rare complication of patients treated with fingolimod. Case presentation Routine MRI eventually led to diagnosis of asymptomatic early PML that remained stable after discontinuation of fingolimod. As blood lymphocyte counts normalized, signs of immune reconstitution inflammatory syndrome (IRIS) and renewed MS activity developed. Both, advanced laboratory and ultrahigh field MRI findings elucidated differences between PML and MS. Conclusions In our case, early discontinuation of fingolimod yielded a good outcome, lymphocyte counts reflected immune system activity, and paraclinical findings helped to differentiate between PML-IRIS and MS.
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Affiliation(s)
- Tim Sinnecker
- Department of Neurology, Universitätsspital, Basel, Switzerland.,Medical Image Analysis Center Basel, Basel, Switzerland
| | - Jeffrie Hadisurya
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany
| | - Tilman Schneider-Hohendorf
- Clinic of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Nicholas Schwab
- Clinic of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Ortwin Adams
- Institute of Virology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany. .,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
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18
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Noureddine Y, Kraff O, Ladd ME, Wrede K, Chen B, Quick HH, Schaefers G, Bitz AK. Radiofrequency induced heating around aneurysm clips using a generic birdcage head coil at 7 Tesla under consideration of the minimum distance to decouple multiple aneurysm clips. Magn Reson Med 2019; 82:1859-1875. [DOI: 10.1002/mrm.27835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Yacine Noureddine
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- MR:comp GmbH, MR Safety Testing Laboratory Gelsenkirchen Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
| | - Mark E. Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ) Heidelberg Germany
- Faculty of Physics and Astronomy and Faculty of Medicine University of Heidelberg Heidelberg Germany
| | - Karsten Wrede
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- Department of Neurosurgery University Hospital Essen Essen Germany
| | - Bixia Chen
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- Department of Neurosurgery University Hospital Essen Essen Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- High Field and Hybrid MR, University Hospital Essen Essen Germany
| | - Gregor Schaefers
- MR:comp GmbH, MR Safety Testing Laboratory Gelsenkirchen Germany
- MRI‐STaR – Magnetic Resonance Institute for Safety, Technology and Research GmbH Gelsenkirchen Germany
| | - Andreas K. Bitz
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ) Heidelberg Germany
- Faculty of Electrical Engineering and Information Technology FH Aachen University of Applied Sciences Aachen NRW Germany
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19
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Dammann P, Wittek P, Darkwah Oppong M, Hütter BO, Jabbarli R, Wrede K, Wanke I, Mönninghoff C, Kaier K, Frank B, Müller O, Kleinschnitz C, Forsting M, Sure U. Relative health-related quality of life after treatment of unruptured intracranial aneurysms: long-term outcomes and influencing factors. Ther Adv Neurol Disord 2019; 12:1756286419833492. [PMID: 30886649 PMCID: PMC6410394 DOI: 10.1177/1756286419833492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022] Open
Abstract
Health-related quality of life (HRQOL) is an important clinical outcome parameter. Its analysis is particularly meaningful to patients with minor functional impairment. The main goal of this study was to assess long-term data of HRQOL and their variables for patients undergoing treatment for unruptured intracranial aneurysms (UIAs). Therefore, a cross-sectional study of HRQOL (SF-36 questionnaire) was conducted in patients treated for UIA using a telephone survey assessing numerous medical and sociodemographic variables. A total of 96 patients with a follow up longer than 36 months post-treatment were included. HRQOL results were compared with the German reference population. Uni- and multivariate analyses were performed to detect variables with an impact on outcome. After a mean follow up of 57.75 ± 13.56 months, patients with treated UIAs showed a significant decrease in the mental health domains ‘role emotional’ and ‘social functioning’ and the ‘mental health component score’ (MHCS) compared with the age- and sex-matched reference population. Overall, 47% of the patients showed a clinically and psychosocially relevant decrease compared with the mean MHCS of the reference population. Multivariate analysis suggests that mainly the treatment modality (coiling versus clipping) and additional remaining untreated UIAs negatively impacted mental HRQOL. In conclusion, the partly significant losses in HRQOL identify the necessity for less-wearing treatment strategies and a better prediction of risk of UIA rupture. Our results indicate that certain factors in the guidance and management of patients undergoing endovascular treatment may negatively affect their mental HRQOL. The relevance of additional UIAs remaining untreated on HRQOL is a new finding that should be considered in the counseling of patients with multiple UIAs.
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Affiliation(s)
- Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Paula Wittek
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | | | - Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christoph Mönninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Benedikt Frank
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | | | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
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20
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Darkwah Oppong M, Gümüs M, Pierscianek D, Herten A, Kneist A, Wrede K, Barthel L, Forsting M, Sure U, Jabbarli R. Aneurysm rebleeding before therapy: a predictable disaster? J Neurosurg 2018; 131:1-8. [PMID: 30544356 DOI: 10.3171/2018.7.jns181119] [Citation(s) in RCA: 7] [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] [Received: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVECurrent guidelines for subarachnoid hemorrhage (SAH) include early aneurysm treatment within 72 hours after ictus. However, aneurysm rebleeding remains a crucial complication of SAH. The aim of this study was to identify independent predictors allowing early stratification of SAH patients for rebleeding risk.METHODSAll patients admitted to the authors' institution with ruptured aneurysms during a 14-year period were eligible for this retrospective study. Demographic and radiographic parameters, aneurysm characteristics, medical history, and medications as well as baseline parameters at admission (blood pressure and laboratory parameters) were evaluated in univariate and multivariate analyses. A novel risk score was created using independent risk factors.RESULTSData from 984 cases could be included into the final analysis. Aneurysm rebleeding occurred in 58 cases (5.9%), and in 48 of these cases (82.8%) rerupture occurred within 24 hours after SAH. Of over 30 tested associations, preexisting arterial hypertension (p = 0.02; adjusted odds ratio [aOR] 2.56, 1 score point), aneurysm location at the basilar artery (p = 0.001, aOR 4.5, 2 score points), sac size ≥ 9 mm (p = 0.04, aOR 1.9, 1 score point), presence of intracerebral hemorrhage (p = 0.001, aOR 4.29, 2 score points), and acute hydrocephalus (p < 0.001, aOR 6.27, 3 score points) independently predicted aneurysm rebleeding. A score built upon these parameters (0-9 points) showed a good diagnostic accuracy (p < 0.001, area under the curve 0.780) for rebleeding prediction.CONCLUSIONSCertain patient-, aneurysm-, and SAH-specific parameters can reliably predict aneurysm rerupture. A score developed according to these parameters might help to identify individuals that would profit from immediate aneurysm occlusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael Forsting
- 2Institute for Diagnostic and Interventional Radiology, University Hospital, University of Duisburg-Essen, Essen, Germany
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21
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Ahmadipour Y, Jabbarli R, Gembruch O, Pierscianek D, Darkwah Oppong M, Dammann P, Wrede K, Özkan N, Müller O, Sure U, El Hindy N. Impact of Multifocality and Molecular Markers on Survival of Glioblastoma. World Neurosurg 2018; 122:e461-e466. [PMID: 30347300 DOI: 10.1016/j.wneu.2018.10.075] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 08/17/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several parameters like extent of resection and MGMT promotor methylation in glioblastoma (GBM) are known to influence survival. Other elements like multifocality and proliferation indices are not commonly used. The aim of the present study was to analyze routinely and not routinely assessed prognostic markers for survival of patients suffering from GBM in a single center. METHODS Adult cases with GBM operated at our institution were included in this survey. The association of age, Karnofsky performance status (KPS), MGMT promotor methylation, Ki67 proliferation index, IDH1/2 mutational status, and multifocality on overall survival (OS) was analyzed in univariate and multivariate cox regression models. RESULTS We analyzed 565 patients with a mean age of 62.2 (18-84) years. Median OS was 12.5 months. MGMT promoter methylation and IDH 1/2 mutation were associated with significant better OS (P < 0.01). In 48 cases (8.5%), the tumor was localized in both hemispheres, which was associated with a significant worse OS than tumor infiltration of 1 hemisphere (P = 0.039). Mean Ki67 proliferation index increased to 18% when both hemispheres were infiltrated. Multivariate analysis for OS revealed IDH 1/2 wildtype (adjusted odds ratio [aOR] 4.3), higher age (aOR 4.2), unmethylated MGMT promotor (aOR 3.5), preoperative KPS score <70 (aOR 1.9), and multifocality (aOR 2.1) as independent parameters for worse survival. CONCLUSIONS This study confirms well-known parameters like MGMT promoter methylation, IDH 1/2 mutational status, KPS, and age as independent prognostic factors for survival and reveals multifocality as further independent prognostic marker for survival. The dismal prognosis of multifocal involvement is associated with an increasing Ki67 proliferation index.
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Affiliation(s)
- Yahya Ahmadipour
- Department of Neurosurgery, University Hospital, Essen, Germany.
| | | | - Oliver Gembruch
- Department of Neurosurgery, University Hospital, Essen, Germany
| | | | | | - Philipp Dammann
- Department of Neurosurgery, University Hospital, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital, Essen, Germany
| | - Neriman Özkan
- Department of Neurosurgery, University Hospital, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital, Essen, Germany; Department of Spine and Peripheral Nerve Surgery, St. Christophorus Hospital, Werne, Germany
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22
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Labrenz F, Ferri F, Wrede K, Forsting M, Schedlowski M, Engler H, Elsenbruch S, Benson S, Costantini M. Altered temporal variance and functional connectivity of BOLD signal is associated with state anxiety during acute systemic inflammation. Neuroimage 2018; 184:916-924. [PMID: 30243957 DOI: 10.1016/j.neuroimage.2018.09.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 04/20/2018] [Revised: 09/17/2018] [Indexed: 12/16/2022] Open
Abstract
Systemic inflammation is accompanied by complex behavioral changes and disturbed emotion regulation that have been related to the pathophysiology of mood disorders including depression and anxiety. However, the causal role of systemic inflammation on mood disorders is still unclear. We herein investigated neural resting state patterns of temporal variance of the amygdala and functional connectivity within the salience network underlying changes in state anxiety during experimentally-induced systemic inflammation. In this randomized, double-blind study, N = 43 healthy men received an intravenous injection of either low-dose lipopolysaccharide (LPS, 0.4 ng/kg body weight) or saline. Resting state functional magnetic resonance imaging was assessed before and 3.5 h after injection. State anxiety, assessed with a standardized questionnaire, and plasma cytokine concentrations were repeatedly measured. LPS administration induced a transient systemic inflammatory response reflected in increases in plasma Interleukin (IL)-6 and Tumor Necrosis Factor (TNF)-α concentration. Compared to placebo, state anxiety and temporal variance in the amygdala significantly increased while functional connectivity in the salience network decreased during LPS-induced systemic inflammation. Together, these data indicate that acute systemic inflammation alters temporal variance of the BOLD signal as well as functional connectivity in brain regions and networks implicated in emotion processing and regulation. These results are of translational importance to encourage further research on the role of inflammatory pathways in the pathophysiology of neuropsychiatric conditions including anxiety disorders.
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Affiliation(s)
- Franziska Labrenz
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Francesca Ferri
- Centre for Brain Science, Department of Psychology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, United Kingdom
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Sigrid Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Sven Benson
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Marcello Costantini
- Department of Neuroscience, Imaging and Clinical Science, University G. d'Annunzio, Via dei Vestini 31, Chieti, Italy.
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Ho MJ, Göricke SL, Mummel P, Mönninghoff C, Wrede K, Wanke I. Stent-assisted treatment of ruptured intracranial aneurysms in the acute phase: A single center experience. eNeurologicalSci 2018; 10:31-36. [PMID: 29736426 PMCID: PMC5933999 DOI: 10.1016/j.ensci.2018.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction The purpose of this study was to analyze the results of patients with ruptured aneurysms who were treated with a specific microstent in the acute phase of subarachnoid hemorrhage. Methods Data from patients with acutely-ruptured intracranial aneurysm treated with the Neuroform stent in the period between 2003 and 2016 were retrospectively assessed, addressing aneurysm occlusion and clinical outcome with a focus on periprocedural complications. Results Twenty-nine consecutive patients with ruptured intracranial aneurysms were included in the analysis. Periprocedural hemorrhagic complications were stated in six patients, leading to death in four. Thromboembolic complications were observed in seven patients, among whom only one affected the clinical outcome with death due to basilar thrombosis. Immediate complete occlusion and occlusion with residual neck was achieved in 79.3% of cases. Conclusion Stent-assisted coiling of acutely-ruptured aneurysms achieves good immediate aneurysm occlusion. Rates of intra- and periprocedural adverse events observed in this series were significant, but did not translate to corresponding morbidity and mortality in all cases. The retrospective analysis did not allow assessing the overall risks of endovascular therapy with stent use in ruptured and complex aneurysm when compared to the overall risks with other alternative options. SAC of acutely ruptured aneurysms achieves good immediate aneurysm occlusion. Adverse events were frequent, but did not translate to morbidity and mortality in all cases. SAC was only applied when alternative strategies would not be considered safe and sufficient.
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Key Words
- AComA, Anterior communicating artery
- AICA, anterior inferior cerebellar artery
- Aneurysm treatment
- BA, Basilar artery
- Cerebral ruptured aneurysm
- DSA, Digital subtraction angiography
- DWI, Diffusion-weighted imaging
- EVD, External ventricular drainage
- HH, Hunt and Hess
- Hemorrhagic complications
- ICA, Internal carotid artery
- MR, Magnetic resonance
- PICA, Posterior inferior cerebellar artery
- PcomA, Posterior communicating artery
- Stent assisted coil embolization
- Subarachnoid hemorrhage
- TOF, Time of flight
- VA, Vertebral artery
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Affiliation(s)
- Michael J Ho
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Petra Mummel
- Department of Neurology, University Hospital of Essen, Germany
| | - Christoph Mönninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.,Klinik Hirslanden, Neuroradiology, Zurich, Switzerland
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Laader A, Beiderwellen K, Kraff O, Maderwald S, Wrede K, Ladd ME, Lauenstein TC, Forsting M, Quick HH, Nassenstein K, Umutlu L. 1.5 versus 3 versus 7 Tesla in abdominal MRI: A comparative study. PLoS One 2017; 12:e0187528. [PMID: 29125850 PMCID: PMC5695282 DOI: 10.1371/journal.pone.0187528] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/21/2017] [Indexed: 01/04/2023] Open
Abstract
Objectives The aim of this study was to investigate and compare the feasibility as well as potential impact of altered magnetic field properties on image quality and potential artifacts of 1.5 Tesla, 3 Tesla and 7 Tesla non-enhanced abdominal MRI. Materials and methods Magnetic Resonance (MR) imaging of the upper abdomen was performed in 10 healthy volunteers on a 1.5 Tesla, a 3 Tesla and a 7 Tesla MR system. The study protocol comprised a (1) T1-weighted fat-saturated spoiled gradient-echo sequence (2D FLASH), (2) T1-weighted fat-saturated volumetric interpolated breath hold examination sequence (3D VIBE), (3) T1-weighted 2D in and opposed phase sequence, (4) True fast imaging with steady-state precession sequence (TrueFISP) and (5) T2-weighted turbo spin-echo (TSE) sequence. For comparison reasons field of view and acquisition times were kept comparable for each correlating sequence at all three field strengths, while trying to achieve the highest possible spatial resolution. Qualitative and quantitative analyses were tested for significant differences. Results While 1.5 and 3 Tesla MRI revealed comparable results in all assessed features and sequences, 7 Tesla MRI yielded considerable differences in T1 and T2 weighted imaging. Benefits of 7 Tesla MRI encompassed an increased higher spatial resolution and a non-enhanced hyperintense vessel signal at 7 Tesla, potentially offering a more accurate diagnosis of abdominal parenchymatous and vasculature disease. 7 Tesla MRI was also shown to be more impaired by artifacts, including residual B1 inhomogeneities, susceptibility and chemical shift artifacts, resulting in reduced overall image quality and overall image impairment ratings. While 1.5 and 3 Tesla T2w imaging showed equivalently high image quality, 7 Tesla revealed strong impairments in its diagnostic value. Conclusions Our results demonstrate the feasibility and overall comparable imaging ability of T1-weighted 7 Tesla abdominal MRI towards 3 Tesla and 1.5 Tesla MRI, yielding a promising diagnostic potential for non-enhanced Magnetic Resonance Angiography (MRA). 1.5 Tesla and 3 Tesla offer comparably high-quality T2w imaging, showing superior diagnostic quality over 7 Tesla MRI.
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Affiliation(s)
- Anja Laader
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, Essen, Germany
- * E-mail:
| | - Karsten Beiderwellen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, Essen, Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | - Mark E. Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, Essen, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Thomas C. Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen, Germany
- Institute of Radiology, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstr. 40, Düsseldorf, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Kokereiallee 7, Essen, Germany
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Chen B, Göricke S, Wrede K, Jabbarli R, Wälchli T, Jägersberg M, Sure U, Dammann P. Reliable? The Value of Early Postoperative Magnetic Resonance Imaging after Cerebral Cavernous Malformation Surgery. World Neurosurg 2017; 103:138-144. [PMID: 28391022 DOI: 10.1016/j.wneu.2017.03.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 12/20/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebral cavernous malformations (CCM) can cause intracerebral hemorrhage. The lesions themselves are frequently associated with perifocal hemosiderin deposits caused by repetitive microhemorrhages. Main indications for a surgical treatment are recurrent symptomatic hemorrhages or cavernoma-related epilepsy. After surgical resection, follow-up magnetic resonance imaging (MRI) is usually performed to confirm 1) the complete resection of the CCM and, especially in cases of cavernoma-related epilepsy, 2) the complete resection of the hemosiderin deposits. METHODS This prospective study evaluates the value of early postoperative MRI (within 72 hours) regarding the detection of CCM or hemosiderin remnants compared with a standard 3-6 months postoperative MRI control in 61 CCM cases. RESULTS Sensitivity of early postoperative MRI for CCM remnant detection was 66.67% (95% confidence interval [CI], 9.43%-99.16%), specificity was 76.74% (95% CI, 61.37%-88.24%), positive predictive value was 16.67% (95% CI, 2.09%-48.41%), and negative predictive value was 97.06% (95% CI, 84.67%-99.93%). Because of the high number of patients who could not be evaluated because of imaging artifacts, sensitivity and specificity analysis was not performed for early postoperative MRI using T2*/susceptibility-weighted imaging to assess hemosiderin remnants. Sensitivity of early postoperative MRI for hemosiderin remnant detection using T2-weighted sequences was 85.71% (95% CI, 63.66%-96.95%), specificity was 66.67% (95% CI, 44.68%-84.37%), positive predictive value was 69.23% (95% CI, 55.45%-80.27%), and negative predictive value was 84.21% (95% CI, 64.31%-94.04%). CONCLUSIONS Our data suggest that early postoperative MRI after CCM surgery is often hampered by imaging artifacts creating false-positive results and therefore ineligible for a resection control. However, reliability of a negative result on early postoperative T2-weighted MRI is relatively high regarding both CCM and hemosiderin remnants.
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Affiliation(s)
- Bixia Chen
- Department of Neurosurgery, University Hospital Essen, Essen, Germany.
| | - Sophia Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Thomas Wälchli
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Max Jägersberg
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, Essen, Germany; Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
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Dammann P, Wrede K, Jabbarli R, Neuschulte S, Menzler K, Zhu Y, Özkan N, Müller O, Forsting M, Rosenow F, Sure U. Outcome after conservative management or surgical treatment for new-onset epilepsy in cerebral cavernous malformation. J Neurosurg 2017; 126:1303-1311. [DOI: 10.3171/2016.4.jns1661] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The aim of this study was to determine seizure outcome, functional outcome, and the withdrawal of antiepileptic drugs (AEDs) after conservative or surgical treatment of patients with new-onset cavernoma-related epilepsy (CRE).
METHODS
The authors conducted a retrospective comparative observational study of 79 consecutive patients, each with a single sporadic cerebral cavernous malformation (CCM) and new-onset CRE.
RESULTS
Forty-one patients underwent initial surgery (IS), and 38 patients underwent initial conservative (IC) treatment. Of those in the latter group, 19 underwent delayed surgical (DS) treatment. At the last follow-up, 88%, 32%, and 79% of patients in the respective groups had been seizure free for at least 2 years (International League Against Epilepsy [ILAE] Class 1; IS vs IC, p < 0.0001) and 78%, 8%, and 58%, respectively, had been off AEDs (IS vs IC, p < 0.0001). The cumulative probability of staying seizure free (ILAE Class 1) during a 5-year period was 73% (mean seizure-free follow-up 49.8 ± 2.7 months, 95% CI 44.4–55.1 months) for the IS group, 22% (mean 31.8 ± 3.6 months, 95% CI 24.8–38.8 months) for the IC group, and 68% (mean 48.6 ± 4.3 months, 95% CI 40.1–57.1 months) for the DS group (IS vs IC p < 0.001). Long-term operative morbidity was 3%, and long-term morbidity in the conservatively treated group was also 3%.
CONCLUSIONS
Patients with CCM and new-onset CRE who underwent IS treatment showed better results in seizure control and the discontinuation of AEDs than the conservatively treated patients. Operative morbidity was comparable to the morbidity from symptomatic CCM hemorrhage in the conservative group. Half of the patients who started with conservative treatment underwent subsequent surgical treatment; however, a longer duration of epilepsy prior to surgery did not worsen postoperative seizure outcome.
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Affiliation(s)
- Philipp Dammann
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Karsten Wrede
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Ramazan Jabbarli
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Salome Neuschulte
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Katja Menzler
- 2Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main
- 3Epilepsy Center Hessen-Marburg, Department of Neurology, Philipps-University, Marburg
| | - Yuan Zhu
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Neriman Özkan
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Oliver Müller
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Michael Forsting
- 4Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - Felix Rosenow
- 2Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main
- 3Epilepsy Center Hessen-Marburg, Department of Neurology, Philipps-University, Marburg
| | - Ulrich Sure
- 1Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
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Dammann P, Wrede K, Jabbarli R, Müller O, Mönninghoff C, Forsting M, Sure U. Of Bubbles and Layers: Which Cerebral Cavernous Malformations are Most Difficult to Dissect From Surrounding Eloquent Brain Tissue? Neurosurgery 2017; 81:498-503. [DOI: 10.1093/neuros/nyx025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 01/14/2017] [Indexed: 11/13/2022] Open
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Deuschl C, Goericke S, Grueneisen J, Sawicki LM, Goebel J, El Hindy N, Wrede K, Binse I, Poeppel T, Quick H, Forsting M, Hense J, Umutlu L, Schlamann M. Simultaneous 11C-Methionine Positron Emission Tomography/Magnetic Resonance Imaging of Suspected Primary Brain Tumors. PLoS One 2016; 11:e0167596. [PMID: 27907162 PMCID: PMC5132315 DOI: 10.1371/journal.pone.0167596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/16/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction The objective of this study was to assess the diagnostic value of integrated 11C- methionine PET/MRI for suspected primary brain tumors, in comparison to MRI alone. Material and Methods Forty-eight consecutive patients with suspected primary brain tumor were prospectively enrolled for an integrated 11C-methionine PET/MRI. Two neuro-radiologists separately evaluated the MRI alone and the integrated PET/MRI data sets regarding most likely diagnosis and diagnostic confidence on a 5-point scale. Reference standard was histopathology or follow-up imaging. Results Fifty-one suspicious lesions were detected: 16 high-grade glioma and 25 low-grade glioma. Ten non-malignant cerebral lesions were described by the reference standard. MRI alone and integrated PET/MRI each correctly classified 42 of the 51 lesions (82.4%) as neoplastic lesions (WHO grade II, III and IV) or non-malignant lesions (infectious and neoplastic lesions). Diagnostic confidence for all lesions, low-grade astrocytoma and high-grade astrocytoma (3.7 vs. 4.2, 3,1 vs. 3.8, 4.0 vs. 4,7) were significantly (p < 0.05) better with integrated PET/MRI than in MRI alone. Conclusions The present study demonstrates the high potential of integrated 11C-methionine-PET/MRI for the assessment of suspected primary brain tumors. Although integrated methionine PET/MRI does not lead to an improvement of correct diagnoses, diagnostic confidence is significantly improved.
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Affiliation(s)
- Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Sophia Goericke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Grueneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lino Morris Sawicki
- Institute of Diagnostic and Interventional Radiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Juliane Goebel
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ina Binse
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Thorsten Poeppel
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Harald Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Joerg Hense
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Department of Neuroradiology, University Hospital Giessen, Gießen, Germany
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Jabbarli R, Pierscianek D, Wrede K, Dammann P, Schlamann M, Forsting M, Müller O, Sure U. Aneurysm remnant after clipping: the risks and consequences. J Neurosurg 2016; 125:1249-1255. [DOI: 10.3171/2015.10.jns151536] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The complete clipping of a cerebral aneurysm usually warrants its sustained occlusion, while clip remnants may have far-reaching consequences. The aim of this study is to identify the risk factors for clip remnants requiring retreatment and/or exhibiting growth.
METHODS
All consecutive patients with primary aneurysm clipping performed at University Hospital of Essen between January 1, 2003, and December 31, 2013, were eligible for this study. Aneurysm occlusion was judged on obligatory postoperative digital subtraction angiography and the need for repeated vascular control. The identified clip remnants were correlated with various demographic and clinical characteristics of the patients, aneurysm features, and surgery-related aspects.
RESULTS
Of 616 primarily clipped aneurysms, postoperative angiography revealed 112 aneurysms (18%) with clip remnants requiring further control (n = 91) or direct retreatment (n = 21). Seven remnants exhibited growth during follow-up, whereas 2 cases were associated with aneurysmal bleeding. Therefore, a total of 28 aneurysms (4.5%) were retreated as clip remnants (range 1 day to 67 months after clipping). In the multivariate analysis, the need for retreatment of clip remnant was correlated with the aneurysm's initial size (> 12 mm; OR 3.22; p = 0.035) and location (anterior cerebral artery > internal carotid artery > posterior circulation > middle cerebral artery; OR 1.85; p = 0.003). Younger age with a cutoff at 45 years (OR 33.31; p = 0.004) was the only independent predictor for remnant growth.
CONCLUSIONS
The size and location of the aneurysm are the main risk factors for clip remnants requiring retreatment. Because of the risk for growth, younger individuals (< 45 years old) with clip remnants require a long-term (> 5 years) vascular follow-up.
Clinical trial registration no: DRKS00008749 (Deutsches Register Klinischer Studien)
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Affiliation(s)
| | | | | | | | - Marc Schlamann
- 2Institute for Diagnostic and Interventional Radiology, University Hospital of Essen, Germany
| | - Michael Forsting
- 2Institute for Diagnostic and Interventional Radiology, University Hospital of Essen, Germany
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Klingbeil J, Stockert A, Wawrzyniak M, Wrede K, Saur D. EP 6. Longitudinal resting state functional connectivity patterns in the early phase of recovery from Aphasia in temporoparietal stroke. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.062] [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: 11/27/2022]
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31
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Stockert A, Klingbeil J, Wawrzyniak M, Wrede K, Saur D. FV 1. Perilesional activation in poststroke language recovery. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.018] [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: 11/29/2022]
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32
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Dammann P, Jabbarli R, Wittek P, Oppong MD, Kneist A, Zhu Y, Wrede K, Müller O, Forsting M, Sure U. Solitary Sporadic Cerebral Cavernous Malformations: Risk Factors of First or Recurrent Symptomatic Hemorrhage and Associated Functional Impairment. World Neurosurg 2016; 91:73-80. [DOI: 10.1016/j.wneu.2016.03.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
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33
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Dammann P, Wrede K, Zhu Y, Matsushige T, Maderwald S, Umutlu L, Quick HH, Hehr U, Rath M, Ladd ME, Felbor U, Sure U. Correlation of the venous angioarchitecture of multiple cerebral cavernous malformations with familial or sporadic disease: a susceptibility-weighted imaging study with 7-Tesla MRI. J Neurosurg 2016; 126:570-577. [PMID: 27153162 DOI: 10.3171/2016.2.jns152322] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple cerebral cavernous malformations (CCMs) are rare lesions that occur in sporadic or familial form. Depending on the disease form, the natural history and treatment of the lesions strongly vary. Molecular analysis of an underlying germline mutation (CCM1-3) is the most sensitive screening method to distinguish between sporadic and familial cases. However, based on the different pathomechanisms that are believed to be involved in either form, significant distinctions in the CCM-associated cerebral venous angioarchitecture should be detectable. This has not been systematically studied. METHODS A consecutive series of 28 patients with multiple CCMs (681 total) diagnosed on 1.5-T MRI underwent genetic screening for CCM1-3 mutations and high-resolution susceptibility-weighted imaging (SWI) of the cerebral venous angioarchitecture with 7-T MRI. Imaging data were analyzed to examine the CCM-associated venous angioarchitecture. Results were correlated with findings of molecular analysis for CCM1-3 mutations. RESULTS Two different SWI patterns (sporadic and familial) were found. The presence of associated developmental venous anomalies correlated with negative screening for germline mutations (11 sporadic) in all cases. All patients with confirmed familial disease showed normal underlying venous angioarchitecture. Additionally, a very unusual case of a probable somatic mutation is presented. CONCLUSIONS The SWI results of the venous angioarchitecture of multiple CCMs correlate with sporadic or familial disease. These results are consistent with the theory that venous anomalies are causative for the sporadic form of multiple CCMs.
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Affiliation(s)
| | | | | | - Toshinori Matsushige
- Department of Neurosurgery.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen
| | - Lale Umutlu
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, and.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen
| | - Harald H Quick
- High Field and Hybrid MR Imaging, University Hospital Essen.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen
| | - Ute Hehr
- Center for and Department of Human Genetics, University of Regensburg
| | - Matthias Rath
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald
| | - Mark E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Ute Felbor
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald
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Özkan N, Wrede K, Ardeshiri A, Sariaslan Z, Stein KP, Dammann P, Müller O, Ringelstein A, Sure U, Sandalcioglu IE. Management of traumatic spinal injuries in children and young adults. Childs Nerv Syst 2015; 31:1139-48. [PMID: 25894756 DOI: 10.1007/s00381-015-2698-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 04/01/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Spinal injuries are rarely seen in pediatric patients and therapeutic options are still poorly defined. The present study is aimed to present our experience with a rather large series of children and young adults suffering from traumatic spinal injury. PATIENTS AND METHODS Between 1990 and 2010, 75 consecutive pediatric patients with spinal injuries were treated in our institution. Mean age was 15 years, ranging from 3 months to 21 years. Radiological findings, treatment strategies, and clinical outcome were evaluated retrospectively and compared with literature. Forty (53.3%) patients were treated conservatively and 35 patients (47%) surgically using anterior or posterior approaches. Subgroup analysis was performed depending on age groups, severity of neurological symptoms, and localization. RESULTS Main trauma mechanisms were fall in 24 patients (38%) and motor vehicle accidents in 21 patients (28%). Complete neurological deficits were present in 17 individuals (23%) and incomplete in 36 patients (48%). Fractures were most frequently localized at the cervical region (56%) with predilection of the C 5/6 segment. Odontoid fractures were seen in 10 (13%) patients. Fractures of the lumbar and thoracic region were rare. Level of injury or clinical course did not differ between the subgroups (≤15 years versus >15 years). CONCLUSION Nearly three fourths of all radiologically detected spinal injuries are located at the cervical spine. Complete neurological deficits after trauma was associated with a poor outcome, in particular for patients with injuries of the upper cervical spine. The use of autologous bone graft was associated with favorable long-term results and should be considered as the material of first choice for vertebral body and disc replacement.
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Affiliation(s)
- Neriman Özkan
- Department of Neurosurgery, University Hospital of Duisburg-Essen, Essen, Germany,
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Umutlu L, Wrede K, Pöttgen C, Pöppel T, Lauenstein T, Forsting M, Schlamann M. Simultane [11C]-Methionin PET/MRT zur Rezidivdiagnostik von hirneigenen Tumoren. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551286] [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: 10/23/2022]
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Umutlu L, Wrede K, Damman P, Forsting M, Schlamann M. 1,5 T versus 7T TOF MRA in der Diagnostik intrakranieller Aneurysmen. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372770] [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: 10/25/2022]
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Wawrzyniak M, Hoffstaedter F, Stockert A, Wrede K, Hartwigsen G, Eickhoff SB, Saur D. Das Sprachnetzwerk gesunder Probanden im Resting-State. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371283] [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: 10/25/2022]
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Mueller O, Hagel V, Wrede K, Schlamann M, Hohn HP, Sure U, Gaul C. Stimulation of the greater occipital nerve: anatomical considerations and clinical implications. Pain Physician 2013; 16:E181-E189. [PMID: 23703417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Stimulation of the greater occipital nerve has been employed for various intractable headache conditions for more than a decade. Still, prospective studies that correlate stimulation of the greater occipital nerve with outcome of patients with respect to alleviation of headache are sparsely found in literature. OBJECTIVE To identify anatomical landmarks for a reproducible stimulation of the greater occipital nerve. For the clinical implication, the individual response to therapy of patients with refractory chronic cluster headache undergoing occipital nerve stimulation was correlated with the postoperative localization of the electrodes and with the distribution of the stimulation field. STUDY DESIGN Prospective observational study, approved by the local research ethics board (09-4143). SETTING University hospital, departments of neurosurgery and neurology, institute of anatomy and radiology. METHODS Ten formaldehyde fixed human cadavers were dissected to identify the passage of the greater occipital nerve through the trapezius muscle. The distance to the external occipital protuberance was triangulated measuring the distance of the nerve from the nuchal midline and the protuberance. Between December 2008 and December 2011, 21 consecutive patients suffering from chronic cluster headache underwent surgery in terms of bilateral occipital nerve stimulation, with electrodes placed horizontally at the level of C1. The postoperative x-rays were compared with the acquired landmarks from the anatomical study. The distribution of the stimulation field was correlated to the individual response of each patient to the therapy and prospectively analyzed with regard to reduction of daily cluster attacks and relief of pain intensity at 3 months and at last follow-up. RESULTS The greater occipital nerve crosses the trapezius muscle at a mean distance of 31 mm below the occipital external protuberance and 14 mm lateral to the midline as found in the anatomical subjects. The electrodes were targeted at this level in all of our patients and stimulated the greater occipital nerve in all patients. Eighteen of the patients (85.7%) reported a significant reduction of the frequency of their cluster attacks and/or declined intensity of pain during the attacks. Yet, 3 of 21 patients (14.3%) did not benefit from the stimulation despite an adequate spread of the stimulation over the occiput. The spread of the stimulation-induced paraesthesias over the occiput was not correlated to a reduction of cluster attacks, to the intensity of attacks, or to the response to treatment at all. LIMITATIONS Single center non-randomized non-blinded study. CONCLUSIONS From our study we conclude that a reproducible stimulation of the greater occipital nerve can be achieved by placing the electrodes parallel to the atlas, at about 30 mm distance to the external occipital protuberance. The response to the stimulation is not correlated to the field width of the paraesthesia. We, therefore, consider stimulation of the main trunk of the greater occipital nerve to be more important than a large field of stimulation on the occiput. Still, an individual response to the occipital nerve stimulation cannot be predicted even by optimal electrode placement.
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Motomura K, Mittelbronn M, Paulus W, Brokinkel B, Keyvani K, Sure U, Wrede K, Nakazato Y, Tanaka Y, Nonoguchi N, Pierscianek D, Kim YH, Mariani L, Vital A, Perry A, Ohgaki H. Abstract 2406: Intra-tumoral heterogeneity of PDGFRA / MET gain in WHO grade II diffuse astrocytomas. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2406] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glioblastomas with a proneural expression signature are characterized by frequent IDH1 mutations (i.e. genetic hallmarks of secondary glioblastomas) and PDGFRA amplification. Most glioblastomas with IDH1 mutations (11/12, 92%) show a proneural signature, the majority with wild-type PDGFRA, while approximately 30% of glioblastomas with a proneural signature had IDH1 mutations. IDH1/2 mutations are frequent and early genetic events in diffuse astrocytomas WHO grade II, precursor to secondary glioblastomas, but little is known about the role and timing of PDGFRA amplification in these tumors.
In the present study, we assessed PDGFRA gain in 342 low-grade diffuse gliomas (166 low-grade diffuse astrocytomas, as well as 61 oligoastrocytomas and 115 oligodendrogliomas) by quantitative PCR. PDGFRA gain was detected in 27/166 (16.3%) diffuse astrocytomas, significantly more frequent than in oligoastrocytomas (6.6%; P=0.04) or in oligodendrogliomas (3/115; 2.6%; P<0.0001).
We correlated PDGFRA gain with other genetic alterations in low-grade diffuse gliomas previously reported from our laboratory. PDGFRA gain was significantly more frequent in diffuse astrocytomas, oligodendrogliomas and low-grade diffuse gliomas without IDH1/2 mutations than those with IDH1/2 mutations (36.8% vs 13.6%; P=0.018, 16.7% vs 1.0%; P=0.028, 24.3% vs 8.3%; P=0.006, respectively). PDGFRA gain was most frequent (28.6%) in gliomas lacking any of common genetic alterations (IDH1/2 mutations, TP53 mutations and 1p/19q loss). PDGFRA gain was found in low-grade diffuse gliomas with TP53 mutation ± IDH1/2 mutations (16.3%) and those with IDH1/2 mutation only (10.5%), but rare in tumors with 1p/19q loss ± IDH1/2 mutations (1.4%).
In diffuse astrocytomas, PDGFRA gain positively correlated with MET gain (P=0.016) and inversely correlated with 1p/19q loss (P=0.005) and IDH1/2 mutations (P=0.018). The vast majority of diffuse astrocytomas showed IDH1/2 mutations and/or PDGFRA gain (154/166; 93%).
Mean survival of diffuse astrocytoma patients with PDGFRA gain was 8.8 ± 1.6 years, similar to that with IDH1/2 mutations (7.8 ± 0.5 years) or TP53 mutations (7.6 ± 0.6 years), but significantly longer than those with MET gain (4.4 ± 0.7 years). The mean survival of diffuse astrocytoma patients with co-gain of MET and PDGFRA was 7.7 ± 2.0 years, which was similar to those with PDGFRA gain only.
Dual-color FISH in 6 diffuse astrocytomas with PDGFRA / MET co-gain identified by quantitative PCR revealed PDGFRA and MET were typically amplified in different tumor cell populations within the tumor, but tumor cells with co-amplification were also focally observed, suggesting intra-tumoral heterogeneity even in diffuse astrocytomas.
Citation Format: Kazuya Motomura, Michel Mittelbronn, Werner Paulus, Benjamin Brokinkel, Kathy Keyvani, Ulrich Sure, Karsten Wrede, Yoichi Nakazato, Yuko Tanaka, Naosuke Nonoguchi, Daniela Pierscianek, Young-Ho Kim, Luigi Mariani, Anne Vital, Arie Perry, Hiroko Ohgaki. Intra-tumoral heterogeneity of PDGFRA / MET gain in WHO grade II diffuse astrocytomas. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2406. doi:10.1158/1538-7445.AM2013-2406
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Affiliation(s)
| | - Michel Mittelbronn
- 2Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt am Main, Germany
| | - Werner Paulus
- 3The Institute of Neuropathology, and the Department of Neurosurgery, University Hospital Munster, Munster, Germany
| | - Benjamin Brokinkel
- 3The Institute of Neuropathology, and the Department of Neurosurgery, University Hospital Munster, Munster, Germany
| | - Kathy Keyvani
- 4The Institute of Pathology and Neuropathology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- 5The Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- 5The Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Yoichi Nakazato
- 6The Department of Pathology, Gunma University, Gunma, Japan
| | - Yuko Tanaka
- 6The Department of Pathology, Gunma University, Gunma, Japan
| | | | | | - Young-Ho Kim
- 1International Agency for Research on Cancer, Lyon, France
| | - Luigi Mariani
- 7The University Hospital, Basel, Switzerland, and the University Hospital, Bern, Switzerland
| | - Anne Vital
- 8The Bordeaux Institute of Neuroscience, CNRS UMR 5293, Bordeaux, France
| | - Arie Perry
- 9Department of Pathology, Division of Neuropathology, University of California, San Francisco, San Francisco, CA
| | - Hiroko Ohgaki
- 1International Agency for Research on Cancer, Lyon, France
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Wrede K, Kotz S, Villringer A, Obrig H. Ereigniskorrelierte Potentiale in der (sub)akuten Phase von Aphasien nach ischämischem Schlaganfall. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337258] [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: 10/27/2022]
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Umutlu L, Maderwald S, Kinner S, Kraff O, Bitz AK, Orzada S, Johst S, Wrede K, Forsting M, Ladd ME, Lauenstein TC, Quick HH. First-pass contrast-enhanced renal MRA at 7 Tesla: initial results. Eur Radiol 2012; 23:1059-66. [PMID: 23064714 DOI: 10.1007/s00330-012-2666-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/28/2012] [Accepted: 09/08/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility of first-pass contrast-enhanced renal MR angiography (MRA) at 7 T. METHODS In vivo first-pass contrast-enhanced high-field examinations were obtained in eight healthy subjects on a 7-T whole-body MRI. A custom-built body transmit/receive radiofrequency (RF) coil and RF system suitable for RF shimming were used for image acquisition. For dynamic imaging, gadobutrol was injected intravenously and coronal unenhanced, arterial and venous data sets using a T1-weighted spoiled gradient-echo sequence were obtained. Qualitative image analysis and assessment of artefact impairment were performed by two senior radiologists using a five-point scale (5 = excellent, 1 = non-diagnostic). SNR and CNR of the perirenal abdominal aorta and both main renal arteries were assessed. RESULTS Qualitative image evaluation revealed overall high-quality delineation of all assessed segments of the unenhanced arterial vasculature (meanunenhanced 4.13). Nevertheless, the application of contrast agent revealed an improvement in vessel delineation of all the vessel segments assessed, confirmed by qualitative (meanunenhanced 4.13 to meancontrast-enhanced 4.85) and quantitative analysis (SNR meanunenhanced 64.3 to meancontrast-enhanced 98.4). CONCLUSION This study demonstrates the feasibility and current constraints of ultra-high-field contrast-enhanced renal MRA relative to unenhanced MRA.
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Affiliation(s)
- L Umutlu
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Arendahls Wiese 199, 45141 Essen, Germany.
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Pierscianek D, Kim YH, Motomura K, Mittelbronn M, Paulus W, Brokinkel B, Keyvani K, Wrede K, Nakazato Y, Tanaka Y, Mariani L, Vital A, Sure U, Ohgaki H. MET gain in diffuse astrocytomas is associated with poorer outcome. Brain Pathol 2012; 23:13-8. [PMID: 22672415 DOI: 10.1111/j.1750-3639.2012.00609.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/11/2012] [Indexed: 12/01/2022] Open
Abstract
Glioblastoma may develop rapidly without evidence for precursor lesions (primary glioblastomas), or progress from diffuse or anaplastic astrocytomas (secondary glioblastomas). Despite having distinct genetic profiles, these glioblastoma subtypes have similar histological features. We hypothesized that the highly malignant phenotype of glioblastoma may be attributable to genetic alterations that are common to both glioblastoma subtypes. In the present study, we first searched for commonly (>35%) amplified genes in glioblastomas with IDH1 mutation (a hallmark of secondary glioblastoma) and those without IDH1 mutation (typical for primary glioblastoma) in data from The Cancer Genome Atlas (TCGA). A total of 25 genes were identified, of which 21 were located at 7q31-34. We then screened 264 gliomas (70 glioblastomas, 112 diffuse astrocytomas, 82 oligodendrogliomas) for gain of the MET at 7q31.2 with quantitative polymerase chain reaction (PCR). MET gain was detected in primary glioblastomas (47%) and secondary glioblastomas (44%), suggesting that this genetic alteration plays a role in the pathogenesis of both glioblastoma subtypes. MET gain was also common in diffuse astrocytomas (38%), but less frequent in oligodendrogliomas (16%). MET gain in diffuse astrocytomas was associated with shorter survival (median, 43.0 vs. 70.7 months; P = 0.004), suggesting that MET gain is a useful prognostic marker for diffuse astrocytomas.
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Affiliation(s)
- Daniela Pierscianek
- Molecular Pathology, International Agency for Research on Cancer, Lyon, France
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Kim YH, Nonoguchi N, Paulus W, Brokinkel B, Keyvani K, Sure U, Wrede K, Mariani L, Giangaspero F, Tanaka Y, Nakazato Y, Vital A, Mittelbronn M, Perry A, Ohgaki H. Frequent BRAF gain in low-grade diffuse gliomas with 1p/19q loss. Brain Pathol 2012; 22:834-40. [PMID: 22568401 DOI: 10.1111/j.1750-3639.2012.00601.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Chromosomal 7q34 duplication and BRAF-KIAA1549 fusion is a characteristic genetic alteration in pilocytic astrocytomas. 7q34 gain appears to be common in diffuse astrocytomas, but its significance is unclear. We assessed BRAF gain and BRAF mutations in 123 low-grade diffuse gliomas, including 55 diffuse astrocytomas, 18 oligoastrocytomas and 50 oligodendrogliomas. Quantitative polymerase chain reaction (PCR) revealed BRAF gain in 17/50 (34%) oligodendrogliomas, a significantly higher frequency than in diffuse astrocytomas (7/55; 13%; P = 0.0112). BRAF gain was common in low-grade diffuse gliomas with 1p/19q loss (39%) and those lacking any of the genetic alterations analyzed (31%), but was rare in those with TP53 mutations (2%). Logistic regression analysis showed a significant positive association between 1p/19q loss and BRAF gain (P = 0.0032) and a significant negative association between TP53 mutations and BRAF gain (P = 0.0042). Fluorescence in situ hybridization (FISH) analysis of 26 low-grade diffuse gliomas with BRAF gain additionally revealed BRAF-KIAA1549 fusion in one oligodendroglioma. Sequencing of cDNA in 17 low-grade diffuse gliomas showed BRAF-KIAA1549 fusion in another oligodendroglioma. A BRAF(V600E) mutation was also detected in one oligodendroglioma, and a BRAF(A598V) in one diffuse astrocytoma. These results suggest that low-grade diffuse gliomas with 1p/19q loss have frequent BRAF gains, and a small fraction of oligodendrogliomas may show BRAF-KIAA1549 fusion.
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Affiliation(s)
- Young-Ho Kim
- International Agency for Research on Cancer, Lyon, France
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Umutlu L, Maderwald S, Kraff O, Kinner S, Schaefer L, Wrede K, Antoch G, Forsting M, Ladd M, Lauenstein T, Quick H. New look at renal vasculature: 7 tesla nonenhanced T1-weighted FLASH imaging. J Magn Reson Imaging 2012; 36:714-21. [DOI: 10.1002/jmri.23702] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 04/12/2012] [Indexed: 11/11/2022] Open
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Umutlu L, Theysohn N, Maderwald S, Wrede K, Dammann P, Ladd ME, Lauenstein TC, Goericke SL, Forsting M, Schlamann U. 7 Tesla Ultrahochfeldbildgebung des intrakraniellen arteriellen Gefäßsystems: native versus kontrastmittelgestützte MPRAGE. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311223] [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: 10/28/2022]
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Kim YH, Lachuer J, Mittelbronn M, Paulus W, Brokinkel B, Keyvani K, Sure U, Wrede K, Nobusawa S, Nakazato Y, Tanaka Y, Vital A, Mariani L, Ohgaki H. Alterations in the RB1 pathway in low-grade diffuse gliomas lacking common genetic alterations. Brain Pathol 2011; 21:645-51. [PMID: 21470325 DOI: 10.1111/j.1750-3639.2011.00492.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We recently reported that the vast majority (>90%) of low-grade diffuse gliomas (diffuse astrocytoma, oligoastrocytoma and oligodendroglioma) carry at least one of the following genetic alterations: IDH1/2 mutation, TP53 mutation or 1p/19q loss. Only 7% of cases were triple-negative (ie, lacking any of these alterations). In the present study, array comparative genomic hybridization (CGH) in 15 triple-negative WHO grade II gliomas (eight diffuse astrocytomas and seven oligodendrogliomas) showed loss at 9p21 (p14(ARF) , p15(INK4b) , p16(INK4a) loci) and 13q14-13q32 (containing the RB1 locus) in three and two cases, respectively. Further analyses in 31 triple-negative cases as well as a total of 160 non-triple-negative cases revealed that alterations in the RB1 pathway (homozygous deletion and promoter methylation of the p15(INK4b) , p16(INK4a) and RB1 genes) were significantly more frequent in triple-negative (26%) than in non-triple-negative cases (11%; P = 0.0371). Multivariate analysis after adjustment for age, histology and treatment showed that RB1 pathway alterations were significantly associated with unfavorable outcome for patients with low-grade diffuse glioma [hazard ratio, 3.024 (1.279-6.631); P = 0.0057]. These results suggest that a fraction of low-grade diffuse gliomas lacking common genetic alterations may develop through a distinct genetic pathway, which may include loss of cell-cycle control regulated by the RB1 pathway.
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Affiliation(s)
- Young-Ho Kim
- International Agency for Research on Cancer, Lyon, France
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Kim YH, Nobusawa S, Mittelbronn M, Paulus W, Brokinkel B, Keyvani K, Sure U, Wrede K, Nakazato Y, Tanaka Y, Vital A, Mariani L, Stawski R, Watanabe T, De Girolami U, Kleihues P, Ohgaki H. Molecular classification of low-grade diffuse gliomas. Am J Pathol 2010; 177:2708-14. [PMID: 21075857 DOI: 10.2353/ajpath.2010.100680] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The current World Health Organization classification recognizes three histological types of grade II low-grade diffuse glioma (diffuse astrocytoma, oligoastrocytoma, and oligodendroglioma). However, the diagnostic criteria, in particular for oligoastrocytoma, are highly subjective. The aim of our study was to establish genetic profiles for diffuse gliomas and to estimate their predictive impact. In this study, we screened 360 World Health Organization grade II gliomas for mutations in the IDH1, IDH2, and TP53 genes and for 1p/19q loss and correlated these with clinical outcome. Most tumors (86%) were characterized genetically by TP53 mutation plus IDH1/2 mutation (32%), 1p/19q loss plus IDH1/2 mutation (37%), or IDH1/2 mutation only (17%). TP53 mutations only or 1p/19q loss only was rare (2 and 3%, respectively). The median survival of patients with TP53 mutation ± IDH1/2 mutation was significantly shorter than that of patients with 1p/19q loss ± IDH1/2 mutation (51.8 months vs. 58.7 months, respectively; P = 0.0037). Multivariate analysis with adjustment for age and treatment confirmed these results (P = 0.0087) and also revealed that TP53 mutation is a significant prognostic marker for shorter survival (P = 0.0005) and 1p/19q loss for longer survival (P = 0.0002), while IDH1/2 mutations are not prognostic (P = 0.8737). The molecular classification on the basis of IDH1/2 mutation, TP53 mutation, and 1p/19q loss has power similar to histological classification and avoids the ambiguity inherent to the diagnosis of oligoastrocytoma.
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Affiliation(s)
- Young-Ho Kim
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
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Giordano M, Luedemann W, Stieglitz L, Wrede K, Columbano L, Samii M. Identification of Venous Variants in the Pineal Region with 3D Preoperative Navigation. A Statistical Study on the Venous Anatomy in the Living. Skull Base 2009. [DOI: 10.1055/s-2009-1222405] [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: 10/20/2022]
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Gerganov VM, Hore N, Herold C, Wrede K, Stan AC, Samii A, Samii M. Bilateral malignant melanoma metastases to the internal auditory canal/cerebellopontine angle: surgical management and preservation of function. J Neurosurg 2008; 108:803-7. [DOI: 10.3171/jns/2008/108/4/0803] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓Although intracranial metastases of malignant melanomas are common, localization at the cerebellopontine angle (CPA) or in the internal auditory canal (IAC) is rare, and bilateral presentation especially so. We present the case of a 46-year-old Caucasian woman with bilateral IAC/CPA lesions and a prior history of malignant melanoma on the right leg. During preoperative investigations, the presence of the bilateral IAC/CPA lesions along with several radiologically identified lesions along the neural axis led to the suspicion that she had neurofibromatosis Type 2 despite her history of malignant melanoma and the lack of characteristic skin lesions and family history. Histopathological analysis of the resected lesion confirmed the intraoperative diagnosis of bilateral CPA malignant melanoma metastases. Surgical removal of the tumors via the retrosigmoid approach with preservation of normal bilateral facial nerve function and unilateral serviceable hearing, combined with control of the systemic disease, provided this patient with a near-normal quality of life for at least 42 months after the initial diagnosis of melanoma.
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Affiliation(s)
| | - Nirjhar Hore
- 1International Neuroscience Institute–Hannover; and
| | | | | | - Alexandru C. Stan
- 2Department of Pathology, Medical University of Hannover, Hannover, Germany
| | - Amir Samii
- 1International Neuroscience Institute–Hannover; and
| | - Madjid Samii
- 1International Neuroscience Institute–Hannover; and
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Wrede K, Kling W. Die Abnahme der Mineralstoffe in erdalkalischen Mineralwässern infolge der Enteisenung. Angew Chem Int Ed Engl 1931. [DOI: 10.1002/ange.19310441703] [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: 11/09/2022]
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