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Zakaria R, Jenkinson MD, Radon M, Das K, Poptani H, Rathi N, Rudland PS. Immune checkpoint inhibitor treatment of brain metastasis associated with a less invasive growth pattern, higher T-cell infiltration and raised tumor ADC on diffusion weighted MRI. Cancer Immunol Immunother 2023; 72:3387-3393. [PMID: 37477652 PMCID: PMC10491542 DOI: 10.1007/s00262-023-03499-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Brain metastases are the most common intracranial tumors with an increasing incidence. They are an important cause of morbidity and mortality in patients with solid organ cancer and a focus of recent clinical research and experimental interest. Immune checkpoint inhibitors are being increasingly used to treat solid organ cancers. METHODS To determine whether immune checkpoint inhibitors were biologically effective in the brain, we compared melanoma brain metastasis samples where treatment with ipilimumab had occurred preoperatively to those who had not received any immune modulating therapy and looked for histopathological (invasion, vascularity, metastasis inducing proteins, matrix metalloproteinases, immune cell infiltration, tissue architecture) and advanced MRI differences (diffusion weighted imaging). RESULTS Co-localized tissue samples from the same regions as MRI regions of interest showed significantly lower vascularity (density of CD34 + vessels) in the core and higher T-cell infiltration (CD3 + cells) in the leading edge for ipilimumab-treated brain metastasis samples than for untreated cases and this correlated with a higher tumor ADC signal at post-treatment/preoperative MRI brain. CONCLUSIONS Treatment of a melanoma brain metastasis with ipilimumab appears to cause measurable biological changes in the tumor that can be correlated with post-treatment diffusion weighted MRI imaging, suggesting both a mechanism of action and a possible surrogate marker of efficacy.
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Affiliation(s)
- Rasheed Zakaria
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Nuffield Building, Crown Street, Liverpool, L69 3BX, UK.
| | - Michael D Jenkinson
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Mark Radon
- Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kumar Das
- Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Harish Poptani
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Nuffield Building, Crown Street, Liverpool, L69 3BX, UK
| | - Nitika Rathi
- Department of Neuropathology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Philip S Rudland
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Nuffield Building, Crown Street, Liverpool, L69 3BX, UK
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Zakaria R, Radon M, Mills S, Mitchell D, Palmieri C, Chung C, Jenkinson MD. The Role of the Immune Response in Brain Metastases: Novel Imaging Biomarkers for Immunotherapy. Front Oncol 2021; 11:711405. [PMID: 34765539 PMCID: PMC8577813 DOI: 10.3389/fonc.2021.711405] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022] Open
Abstract
Brain metastases are a major clinical problem, and immunotherapy offers a novel treatment paradigm with the potential to synergize with existing focal therapies like surgery and radiosurgery or even replace them in future. The brain is a unique microenvironment structurally and immunologically. The immune response is likely to be crucial to the adaptation of systemic immune modulating agents against this disease. Imaging is frequently employed in the clinical diagnosis and management of brain metastasis, so it is logical that brain imaging techniques are investigated as a source of biomarkers of the immune response in these tumors. Current imaging techniques in clinical use include structural MRI (post-contrast T1W sequences, T2, and FLAIR), physiological sequences (perfusion- and diffusion-weighted imaging), and molecular imaging (MR spectroscopy and PET). These are reviewed for their application to predicting and measuring the response to immunotherapy in brain metastases.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, University of Texas M.D.Anderson Cancer Center, Houston, TX, United States
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mark Radon
- Department of Radiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Samantha Mills
- Department of Radiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Drew Mitchell
- Department of Imaging Physics, University of Texas M.D.Anderson Cancer Center, Houston, TX, United States
| | - Carlo Palmieri
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas M.D.Anderson Cancer Center, Houston, TX, United States
| | - Michael D. Jenkinson
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Hannan CJ, Daousi C, Radon M, Gilkes CE. 3 Tesla intra-operative MRI as an adjunct to endoscopic pituitary surgery: an early assessment of clinical utility. Br J Neurosurg 2021:1-9. [PMID: 34585644 DOI: 10.1080/02688697.2021.1981237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extent of resection is a major determinant of outcomes following pituitary surgery. Intra-operative magnetic resonance imaging (iMRI), provides an immediate assessment of the extent of resection, allowing further tumour resection during the same procedure. However, such systems are expensive and significantly increase operative time, prompting some authors to question the additional benefit conferred by iMRI when combined with endoscopy. Our aim was to assess the impact of combining 3 T iMRI with endoscopy in patients with pituitary tumours. METHODS We retrospectively reviewed a prospectively maintained database to identify patients who underwent iMRI guided endoscopic resection of pituitary tumours between May 2017 and November 2018 (iMRI cohort). This cohort was compared with a pre-iMRI cohort of patients who underwent endoscopic resection of pituitary adenomas. Operative time, extent of resection, control of endocrine disease and post-operative complications were recorded and analysed. RESULTS Thirty-seven patients were included in each cohort. iMRI facilitated additional tumour resection in 6/37 (16%) of cases. In 4/37 cases (11%), iMRI prompted a return to theatre but no further tumour could be identified. The overall GTR rate, following iMRI was 24/37 (65%) as compared to 21/37 (57%) in the pre-iMRI cohort. Cure of endocrine disease associated with hormonally active tumours was achieved in 9/11 (82%) of cases in the iMRI cohort. The mean operative time in the iMRI cohort was 327 minutes (five hours 27 minutes). CONCLUSIONS 3 T iMRI provides immediate identification of residual tumour following endoscopic pituitary surgery. This allows for resection of surgically accessible residual disease during the same procedure and is likely to reduce the requirement for later re-intervention. However, the use of iMRI in this setting is associated with significant resource allocation issues which must be considered prior to the widespread adoption of this technique.
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Affiliation(s)
- Cathal John Hannan
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christina Daousi
- Department of Endocrinology, Aintree University Hospital, Liverpool, UK
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mark Radon
- Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, UK
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Abstract
Over the past 3 years, gadolinium-based contrast agents have been linked to MRI signal changes in the brain, which have been found to be secondary to gadolinium deposition in the brain, particularly in the dentate nuclei and globus pallidus even in patients having an intact blood-brain barrier and a normal renal function. This tends to occur more in linear agents than with macrocyclic agents. Nonetheless, there has been no significant evidence that this has any clinical consequence. We reviewed the current evidence related to this new phenomenon and the precautionary approach taken by regulatory agencies.
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Affiliation(s)
- Richard Pullicino
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK.
| | - Mark Radon
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Shubhabrata Biswas
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Maneesh Bhojak
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Kumar Das
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
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Zakaria R, Platt-Higgins A, Rathi N, Radon M, Das S, Das K, Bhojak M, Brodbelt A, Chavredakis E, Jenkinson MD, Rudland PS. T-Cell Densities in Brain Metastases Are Associated with Patient Survival Times and Diffusion Tensor MRI Changes. Cancer Res 2017; 78:610-616. [PMID: 29212855 DOI: 10.1158/0008-5472.can-17-1720] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/15/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022]
Abstract
Brain metastases are common and are usually detected by MRI. Diffusion tensor imaging (DTI) is a derivative MRI technique that can detect disruption of white matter tracts in the brain. We have matched preoperative DTI with image-guided sampling of the brain-tumor interface in 26 patients during resection of a brain metastasis and assessed mean diffusivity and fractional anisotropy (FA). The tissue samples were analyzed for vascularity, inflammatory cell infiltration, growth pattern, and tumor expression of proteins associated with growth or local invasion such as Ki67, S100A4, and MMP2, 9, and 13. A lower FA in the peritumoral region indicated more white matter tract disruption and independently predicted longer overall survival times (HR for death = 0.21; 95% confidence interval, 0.06-0.82; P = 0.024). Of all the biological markers studied, only increased density of CD3+ lymphocytes in the same region correlated with decreased FA (Mann-Whitney U, P = 0.037) as well as confounding completely the effect of FA on multivariate survival analyses. We conclude that the T-cell response to brain metastases is not a surrogate of local tumor invasion, primary cancer type, or aggressive phenotype and is associated with patient survival time regardless of these biological factors. Furthermore, it can be assayed by DTI, potentially offering a quick, noninvasive, clinically available method to detect an active immune microenvironment and, in principle, to measure susceptibility to immunotherapy.Significance: These findings show that white matter tract integrity is degraded in areas where T-cell infiltration is highest, providing a noninvasive method to identify immunologically active microenvironments in secondary brain tumors. Cancer Res; 78(3); 610-6. ©2017 AACR.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom. .,Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Angela Platt-Higgins
- Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Nitika Rathi
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Mark Radon
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Sumit Das
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Kumar Das
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Maneesh Bhojak
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Emmanuel Chavredakis
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.,Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Philip S Rudland
- Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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Randall A, Ellis RJB, Hywel B, McCoy CA, Davies R, Eldridge PR, Putharan M, Radon M, Alusi S. DURAL AVF CAUSING A TREATABLE CJD LIKE COGNITIVE DYSFUNCTION. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 67-year-old woman presented with a seven-month history of progressive psychiatric disturbance and sub-acute cognitive decline mimicking Creuztfeldt-Jakob Disease.She presented initially to Psychiatry with worsening anxiety, depression, lassitude, impaired concentration and insomnia. She was given a diagnosis of agitated depression.She subsequently experienced episodes of disorientation, indecision and inability to complete routine, learned tasks as well as visual hallucinations. Initial investigations for causes of subacute dementia were unremarkable including a non-diagnostic MRI. However, five months into her presentation, there was further rapid deterioration with fluctuating consciousness and deteriorating mobility. She became bedbound, incontinent and cortically blind. She had right hemiparesis, hemineglect, extrapyramidal features, and extensor plantars.A 4D computerised tomography angiogram demonstrated a dural arteriovenous (AV) fistula with retrograde filling of superior sagittal sinus and cortical venous congestion. She underwent emergency Onyx embolisation. Over a few weeks, there was gradual improvement in her anxiety, cognition and mobility. She had a mild residual right hemiparesis.Intracranial dural AV fistulae can present with a spectrum of neurological symptoms, including cognitive decline. A lowhigh index of suspicion combined with close liaison between Neuroradiology, Neurology and Neurosurgery ensures prompt diagnosis and maximises the potential for cognitive recovery.
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Biswas S, Chandran A, Radon M, Puthuran M, Bhojak M, Nahser HC, Das K. Accuracy of four-dimensional CT angiography in detection and characterisation of arteriovenous malformations and dural arteriovenous fistulas. Neuroradiol J 2015; 28:376-84. [PMID: 26427892 DOI: 10.1177/1971400915604526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A retrospective review was made to assess the accuracy of four dimensional CT angiogram (4D-CTA) in diagnosis of arteriovenous malformations (AVM) and dural arteriovenous fistulas (DAVF), with catheter-based digital-subtraction angiogram (DSA) being gold standard. 33 pairs of investigations (DSA and 4D-CTA) were performed primarily for suspicion of AVM/DAVF. Based on blinded reports, sensitivity and specificity for detection of AVM/DAVF were 77% (95% CI: 46-95%) and 100% (95% CI: 83-100%) respectively. Positive predictive value was 100% (95% CI: 69-100%) and negative predictive value 87% (95% CI: 66-97%). 4D-CTA is a practical minimally-invasive technique for evaluating cerebrovascular pathologies. There is good agreement between the findings of 4D-CTA and DSA despite the differences in temporal and spatial resolutions. 4D-CTA may obviate the need for DSA in a subgroup of patients who would otherwise have undergone this invasive investigation, which carries a risk of important complications.
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Affiliation(s)
- Shubhabrata Biswas
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, UK
| | - Arun Chandran
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, UK
| | - Mark Radon
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, UK
| | - Mani Puthuran
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, UK
| | - Maneesh Bhojak
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, UK
| | | | - Kumar Das
- Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, UK
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Chandran A, Radon M, Biswas S, Das K, Puthuran M, Nahser H. Republished: Novel use of 4D-CTA in imaging of intranidal aneurysms in an acutely ruptured arteriovenous malformation: is this the way forward? J Neurointerv Surg 2015; 8:e36. [DOI: 10.1136/neurintsurg-2015-011784.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 11/04/2022]
Abstract
Ruptured arteriovenous malformation (AVM) is a frequent cause of intracranial hemorrhage. The presence of associated aneurysms, especially intranidal aneurysms, is considered to increase the risk of re-hemorrhage. We present two cases where an intranidal aneurysm was demonstrated on four-dimensional CT angiography (time-resolved CT angiography) (4D-CTA). These features were confirmed by digital subtraction angiography (catheter arterial angiogram). This is the first report of an intranidal aneurysm demonstrated by 4D-CTA. 4D-CTA can offer a comprehensive evaluation of the angioarchitecture and flow dynamics of an AVM for appropriate classification and management.
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Chandran A, Radon M, Biswas S, Das K, Puthuran M, Nahser H. Novel use of 4D-CTA in imaging of intranidal aneurysms in an acutely ruptured arteriovenous malformation: is this the way forward? BMJ Case Rep 2015; 2015:bcr-2015-011784. [PMID: 26153283 DOI: 10.1136/bcr-2015-011784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/04/2022] Open
Abstract
Ruptured arteriovenous malformation (AVM) is a frequent cause of intracranial hemorrhage. The presence of associated aneurysms, especially intranidal aneurysms, is considered to increase the risk of re-hemorrhage. We present two cases where an intranidal aneurysm was demonstrated on four-dimensional CT angiography (time-resolved CT angiography) (4D-CTA). These features were confirmed by digital subtraction angiography (catheter arterial angiogram). This is the first report of an intranidal aneurysm demonstrated by 4D-CTA. 4D-CTA can offer a comprehensive evaluation of the angioarchitecture and flow dynamics of an AVM for appropriate classification and management.
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Affiliation(s)
- Arun Chandran
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Mark Radon
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Shubhabrata Biswas
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Kumar Das
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Mani Puthuran
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Hans Nahser
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
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Zakaria R, Radon M, Bhojak M, Sluming V, Das K, Jenkinson MD. O04 * DIFFUSION WEIGHTED MRI DISCRIMINATES PRIMARY CANCER TYPE AND OUTCOME IN BRAIN METASTASES. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou250.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zakaria R, Das K, Radon M, Bhojak M, Rudland PR, Sluming V, Jenkinson MD. Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes. BMC Med Imaging 2014; 14:26. [PMID: 25086595 PMCID: PMC4126355 DOI: 10.1186/1471-2342-14-26] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 04/24/2014] [Accepted: 07/24/2014] [Indexed: 12/27/2022] Open
Abstract
Background Diffusion-weighted MRI (DWI) has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. There is evidence from other solid organ cancers and metastases that DWI may be used as a biomarker of prognosis and treatment response. We therefore investigated DWI characteristics of cerebral metastases and their peritumoral region recorded pre-operatively and related these to patient outcomes. Methods Retrospective analysis of 76 cases operated upon at a single institution with DWI performed pre-operatively at 1.5T. Maps of apparent diffusion coefficient (ADC) were generated using standard protocols. Readings were taken from the tumor, peritumoral region and across the brain-tumor interface. Patient outcomes were overall survival and time to local recurrence. Results A minimum ADC greater than 919.4 × 10-6 mm2/s within a metastasis predicted longer overall survival regardless of adjuvant therapies. This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer. The change in diffusion across the tumor border and into peritumoral brain was measured by the “ADC transition coefficient” or ATC and this was more strongly predictive than ADC readings alone. Metastases with a sharp change in diffusion across their border (ATC >0.279) showed shorter overall survival compared to those with a more diffuse edge. The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 – 0.97, p = 0.04). Conclusions DWI demonstrates changes in the tumor, across the tumor edge and in the peritumoral region which may not be visible on conventional MRI and this may be useful in predicting patient outcomes for operated cerebral metastases.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
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Zakaria R, Das K, Bhojak M, Radon M, Walker C, Jenkinson MD. The role of magnetic resonance imaging in the management of brain metastases: diagnosis to prognosis. Cancer Imaging 2014; 14:8. [PMID: 25608557 PMCID: PMC4331840 DOI: 10.1186/1470-7330-14-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/11/2014] [Indexed: 11/20/2022] Open
Abstract
This article reviews the different MRI techniques available for the diagnosis, treatment and monitoring of brain metastases with a focus on applying advanced MR techniques to practical clinical problems. Topics include conventional MRI sequences and contrast agents, functional MR imaging, diffusion weighted MR, MR spectroscopy and perfusion MR. The role of radiographic biomarkers is discussed as well as future directions such as molecular imaging and MR guided high frequency ultrasound.
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Abstract
OBJECTIVES The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ). METHODS MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized. RESULTS There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention. CONCLUSIONS Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.
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Affiliation(s)
- J Makdissi
- Dental and Maxillofacial Radiology, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Iniesta I, Radon M, Pinder C. Methyl iodide rhombencephalopathy: clinico-radiological features of a preventable, potentially fatal industrial accident. Pract Neurol 2013; 13:393-5. [PMID: 23847234 DOI: 10.1136/practneurol-2013-000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ivan Iniesta
- Department of Neurology, The Walton Centre Foundation Trust, , Liverpool, Merseyside, UK
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Storoni M, Davagnanam I, Radon M, Siddiqui A, Plant GT. Distinguishing Optic Neuritis in Neuromyelitis Optica Spectrum Disease From Multiple Sclerosis. J Neuroophthalmol 2013; 33:123-7. [DOI: 10.1097/wno.0b013e318283c3ed] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
As there is little information regarding the recovery from Uhthoff phenomenon (UP) in the multiple sclerosis (MS) literature, the objective of this study was to assess the phenotypes of UP. A one-page questionnaire was sent to 80 consecutive optic neuritis (ON) patients seen in a tertiary neuro-ophthalmology clinic. Of the 48 responders to the questionnaire, 52% reported experiencing UP, with a range of follow-up from 1 to 20 years. Only 16% had resolution of UP, all this occurred within 8 weeks of the onset of ON. Of the MS patients with UP, 88% experienced non-visual heat-related phenomenon compared with 30% without UP. The presence of UP may have a more general phenotypic significance. If full recovery from UP has not occurred within the first 2 months from the onset of ON, then recovery appears to be uncommon and may therefore be a surrogate marker of remyelination in future drug trials.
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Affiliation(s)
- Clare L Fraser
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, UK.
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Condliffe R, Radon M, Hurdman J, Davies C, Hill C, Akil M, Guarasci F, Rajaram S, Swift AJ, Wragg Z, van Beek E, Elliot CA, Kiely DG. CT pulmonary angiography combined with echocardiography in suspected systemic sclerosis-associated pulmonary arterial hypertension. Rheumatology (Oxford) 2011; 50:1480-6. [PMID: 21447566 DOI: 10.1093/rheumatology/ker114] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Echocardiography is widely used in the investigation of patients with suspected SSc-associated pulmonary arterial hypertension (SSc-PAH). We investigated whether CT pulmonary angiography (CTPA) provides additive diagnostic value. METHODS Data for 89 consecutive patients with suspected SSc-PAH undergoing echocardiography, CTPA and right heart catheterization were reviewed. Pulmonary artery diameter (dPA) and ascending aorta diameter (dAA), right and left ventricular diameter (dRV and dLV) and grade of tricuspid regurgitation (TR(CT)) measured at CTPA and tricuspid gradient (TG(ECHO)) at echocardiography were retrieved. A predictive equation for mean pulmonary arterial pressure (mPAP) was derived using multivariate linear regression. Multivariate Cox regression analysis was then used to assess the prognostic strength of CTPA parameters and TG(ECHO). RESULTS Absolute measures of dPA and dRV correlated weakly with mPAP. However, dPA : dAA and dRV : dLV showed stronger correlations with mPAP (dPA : dAA r = 0.42, P < 0.001; dRV : dLV r = 0.51, P < 0.001). dRV : dLV correlated more strongly with pulmonary vascular resistance than did dPA : dAA (r = 0.63 vs 0.39, P both <0.001). dPA : dAA and TG(ECHO) were independent predictors of mPAP. A derived CT/echo composite index had a higher predictive accuracy (area under the curve = 0.95) than dPA : dAA or TG(ECHO) although negative predictive value (NPV) was only 77%. Combining the CT/echo composite index with presence or absence of TR(CT) increased NPV to 100% although this observation requires further validation. dRV : dLV was the strongest prognostic factor. CONCLUSION In suspected SSc-PAH, cardiac chamber and great vessel measurements at CTPA correlate with pulmonary haemodynamics and predict survival. In combination with echocardiography CTPA increases diagnostic accuracy and may identify other potential causes of breathlessness.
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Affiliation(s)
- Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.
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Haupt R, Pieper KS, Heilmann HH, Lindenhayn K, Bähr B, Radon M, Kässner A, Regling G, Marks P, Engelmann L. The influence of mechanical loading on the knee-joint. Animal-experimental examinations. Beitr Orthop Traumatol 1989; 36:185-93. [PMID: 2751624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A physiological maximal loading of the knee-joint of sheep is simulated by a 4-hour peak overloading of 24.5 N and a frequency of 42 impulses per minute. The reactions of articular cartilage, synovia and periarticular muscular tissue to the load were examined histologically, histochemically and biochemically. 20 hours after the loading we could observe a leucocytic influx into the joint and a metabolic hyperactivity in the examined tissue. The changes found during this acute phase are reversible as 180 days after peak overloading the parameters detected to be changed had returned to normal again.
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