1
|
Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, Batra PS, Bhayani M, Bell D, Bernal-Sprekelsen M, Betz CS, Blay JY, Bleier BS, Bonilla-Velez J, Callejas C, Carrau RL, Casiano RR, Castelnuovo P, Chandra RK, Chatzinakis V, Chen SB, Chiu AG, Choby G, Chowdhury NI, Citardi MJ, Cohen MA, Dagan R, Dalfino G, Dallan I, Dassi CS, de Almeida J, Dei Tos AP, DelGaudio JM, Ebert CS, El-Sayed IH, Eloy JA, Evans JJ, Fang CH, Farrell NF, Ferrari M, Fischbein N, Folbe A, Fokkens WJ, Fox MG, Lund VJ, Gallia GL, Gardner PA, Geltzeiler M, Georgalas C, Getz AE, Govindaraj S, Gray ST, Grayson JW, Gross BA, Grube JG, Guo R, Ha PK, Halderman AA, Hanna EY, Harvey RJ, Hernandez SC, Holtzman AL, Hopkins C, Huang Z, Huang Z, Humphreys IM, Hwang PH, Iloreta AM, Ishii M, Ivan ME, Jafari A, Kennedy DW, Khan M, Kimple AJ, Kingdom TT, Knisely A, Kuo YJ, Lal D, Lamarre ED, Lan MY, Le H, Lechner M, Lee NY, Lee JK, Lee VH, Levine CG, Lin JC, Lin DT, Lobo BC, Locke T, Luong AU, Magliocca KR, Markovic SN, Matnjani G, McKean EL, Meço C, Mendenhall WM, Michel L, Na'ara S, Nicolai P, Nuss DW, Nyquist GG, Oakley GM, Omura K, Orlandi RR, Otori N, Papagiannopoulos P, Patel ZM, Pfister DG, Phan J, Psaltis AJ, Rabinowitz MR, Ramanathan M, Rimmer R, Rosen MR, Sanusi O, Sargi ZB, Schafhausen P, Schlosser RJ, Sedaghat AR, Senior BA, Shrivastava R, Sindwani R, Smith TL, Smith KA, Snyderman CH, Solares CA, Sreenath SB, Stamm A, Stölzel K, Sumer B, Surda P, Tajudeen BA, Thompson LDR, Thorp BD, Tong CCL, Tsang RK, Turner JH, Turri-Zanoni M, Udager AM, van Zele T, VanKoevering K, Welch KC, Wise SK, Witterick IJ, Won TB, Wong SN, Woodworth BA, Wormald PJ, Yao WC, Yeh CF, Zhou B, Palmer JN. International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors. Int Forum Allergy Rhinol 2024; 14:149-608. [PMID: 37658764 DOI: 10.1002/alr.23262] [Citation(s) in RCA: 2] [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] [Received: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. METHODS In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. RESULTS The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. CONCLUSION As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.
Collapse
Affiliation(s)
- Edward C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Borislav Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mihir Bhayani
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Department, Surgery and Medical-Surgical Specialties Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Christian S Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, UNICANCER, Université Claude Bernard Lyon I, Lyon, France
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Claudio Callejas
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Roy R Casiano
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Simon B Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Iacopo Dallan
- Department of Otolaryngology-Head and Neck Surgery, Pisa University Hospital, Pisa, Italy
| | | | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Angelo P Dei Tos
- Section of Pathology, Department of Medicine, University of Padua, Padua, Italy
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James J Evans
- Department of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nyssa F Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Nancy Fischbein
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Adam Folbe
- Department of Otolaryngology-Head and Neck Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Meha G Fox
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Christos Georgalas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of South Wales, Sydney, New South Wales, Australia
| | - Stephen C Hernandez
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohemmed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ming-Ying Lan
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matt Lechner
- UCL Division of Surgery and Interventional Science and UCL Cancer Institute, University College London, London, UK
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor H Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Brian C Lobo
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Svetomir N Markovic
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gesa Matnjani
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cem Meço
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
- Department of Otorhinolaryngology Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Loren Michel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shorook Na'ara
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Daniel W Nuss
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Gurston G Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gretchen M Oakley
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Richard R Orlandi
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alkis J Psaltis
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc R Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olabisi Sanusi
- Department of Neurosurgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philippe Schafhausen
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Raj Shrivastava
- Department of Neurosurgery and Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carl H Snyderman
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Aldo Stamm
- São Paulo ENT Center (COF), Edmundo Vasconcelos Complex, São Paulo, Brazil
| | - Katharina Stölzel
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Baran Sumer
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pavol Surda
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond K Tsang
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Aaron M Udager
- Department of Pathology, Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thibaut van Zele
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Stephanie N Wong
- Division of Otorhinolaryngology, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Rogawski D, Wheeler J, Nie E, Zhu W, Villanueva E, Coffey G, Ma Q, Ganjoo K, Fischbein N, Iv M, Vogel H, Nagpal S. A rare non-gadolinium enhancing sarcoma brain metastasis with microenvironment dominated by tumor-associated macrophages. Acta Neuropathol Commun 2024; 12:15. [PMID: 38254244 PMCID: PMC10804641 DOI: 10.1186/s40478-023-01713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/17/2023] [Indexed: 01/24/2024] Open
Abstract
Brain metastases occur in 1% of sarcoma cases and are associated with a median overall survival of 6 months. We report a rare case of a brain metastasis with unique radiologic and histopathologic features in a patient with low grade fibromyxoid sarcoma (LGFMS) previously treated with immune checkpoint inhibitor (ICI) therapy. The lone metastasis progressed in the midbrain tegmentum over 15 months as a non-enhancing, T2-hyperintense lesion with peripheral diffusion restriction, mimicking a demyelinating lesion. Histopathology of the lesion at autopsy revealed a rich infiltrate of tumor-associated macrophages (TAMs) with highest density at the leading edge of the metastasis, whereas there was a paucity of lymphocytes, suggestive of an immunologically cold environment. Given the important immunosuppressive and tumor-promoting functions of TAMs in gliomas and carcinoma/melanoma brain metastases, this unusual case provides an interesting example of a dense TAM infiltrate in a much rarer sarcoma brain metastasis.
Collapse
Affiliation(s)
- David Rogawski
- Division of Neuro-Oncology, Stanford Medicine, Stanford, CA, 94305, USA.
| | - Joshua Wheeler
- Division of Neuropathology, Department of Pathology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Esther Nie
- Division of Neuroimmunology, Stanford Medicine, Stanford, CA, 94305, USA
| | - William Zhu
- Department of Neurology and Neurological Sciences, Stanford Medicine, Stanford, CA, 94305, USA
| | | | - Gwen Coffey
- Division of Neuro-Oncology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Qian Ma
- Department of Neurology and Neurological Sciences, Stanford Medicine, Stanford, CA, 94305, USA
| | - Kristen Ganjoo
- Division of Oncology, Department of Medicine, Stanford Medicine, Stanford, CA, 94305, USA
| | - Nancy Fischbein
- Division of Neuroradiology, Department of Radiology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Michael Iv
- Division of Neuroradiology, Department of Radiology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Hannes Vogel
- Division of Neuropathology, Department of Pathology, Stanford Medicine, Stanford, CA, 94305, USA
| | - Seema Nagpal
- Division of Neuro-Oncology, Stanford Medicine, Stanford, CA, 94305, USA
| |
Collapse
|
3
|
Kumar KK, Toland A, Fischbein N, Morrell M, Heit JJ, Born DE, Steinberg GK. Vascular anomaly, lipoma, and polymicrogyria associated with schizencephaly: developmental and diagnostic insights. Illustrative case. J Neurosurg Case Lessons 2023; 5:CASE2388. [PMID: 37218736 PMCID: PMC10550650 DOI: 10.3171/case2388] [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] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Schizencephaly is an uncommon central nervous system malformation. Intracranial lipomas are also rare, accounting for approximately 0.1% of brain "tumors." They are believed to be derived from a persistent meninx primitiva, a neural crest-derived mesenchyme that develops into the dura and leptomeninges. OBSERVATIONS The authors present a case of heterotopic adipose tissue and a nonshunting arterial vascular malformation arising within a schizencephalic cleft in a 22-year-old male. Imaging showed right frontal gray matter abnormality and an associated suspected arteriovenous malformation with evidence of hemorrhage. Brain magnetic resonance imaging revealed right frontal polymicrogyria lining an open-lip schizencephaly, periventricular heterotopic gray matter, fat within the schizencephalic cleft, and gradient echo hypointensity concerning for prior hemorrhage. Histological assessment demonstrated mature adipose tissue with large-bore, thick-walled, irregular arteries. Mural calcifications and subendothelial cushions suggesting nonlaminar blood flow were observed. There were no arterialized veins or direct transitions from the arteries to veins. Hemosiderin deposition was scant, and hemorrhage was not present. The final diagnosis was consistent with ectopic mature adipose tissue and arteries with meningocerebral cicatrix. LESSONS This example of a complex maldevelopment of derivatives of the meninx primitiva in association with cortical maldevelopment highlights the unique challenges from both a radiological and histological perspective during diagnostic workup.
Collapse
Affiliation(s)
| | - Angus Toland
- Department of Pathology, Texas Children’s Hospital, Houston, Texas
| | | | | | | | - Donald E. Born
- Pathology, Stanford University School of Medicine, Stanford, California; and
| | | |
Collapse
|
4
|
Wardak M, Sonni I, Fan AP, Minamimoto R, Jamali M, Hatami N, Zaharchuk G, Fischbein N, Nagpal S, Li G, Koglin N, Berndt M, Bullich S, Stephens AW, Dinkelborg LM, Abel T, Manning HC, Rosenberg J, Chin FT, Sam Gambhir S, Mittra ES. 18F-FSPG PET/CT Imaging of System x C- Transporter Activity in Patients with Primary and Metastatic Brain Tumors. Radiology 2022; 303:620-631. [PMID: 35191738 DOI: 10.1148/radiol.203296] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The PET tracer (4S)-4-(3-[18F]fluoropropyl)-l-glutamate (18F-FSPG) targets the system xC- cotransporter, which is overexpressed in various tumors. Purpose To assess the role of 18F-FSPG PET/CT in intracranial malignancies. Materials and Methods Twenty-six patients (mean age, 54 years ± 12; 17 men; 48 total lesions) with primary brain tumors (n = 17) or brain metastases (n = 9) were enrolled in this prospective, single-center study (ClinicalTrials.gov identifier: NCT02370563) between November 2014 and March 2016. A 30-minute dynamic brain 18F-FSPG PET/CT scan and a static whole-body (WB) 18F-FSPG PET/CT scan at 60-75 minutes were acquired. Moreover, all participants underwent MRI, and four participants underwent fluorine 18 (18F) fluorodeoxyglucose (FDG) PET imaging. PET parameters and their relative changes were obtained for all lesions. Kinetic modeling was used to estimate the 18F-FSPG tumor rate constants using the dynamic and dynamic plus WB PET data. Imaging parameters were correlated to lesion outcomes, as determined with follow-up MRI and/or pathologic examination. The Mann-Whitney U test or Student t test was used for group mean comparisons. Receiver operating characteristic curve analysis was used for performance comparison of different decision measures. Results 18F-FSPG PET/CT helped identify all 48 brain lesions. The mean tumor-to-background ratio (TBR) on the whole-brain PET images at the WB time point was 26.6 ± 24.9 (range: 2.6-150.3). When 18F-FDG PET was performed, 18F-FSPG permitted visualization of non-18F-FDG-avid lesions or allowed better lesion differentiation from surrounding tissues. In participants with primary brain tumors, the predictive accuracy of the relative changes in influx rate constant Ki and maximum standardized uptake value to discriminate between poor and good lesion outcomes were 89% and 81%, respectively. There were significant differences in the 18F-FSPG uptake curves of lesions with good versus poor outcomes in the primary brain tumor group (P < .05) but not in the brain metastases group. Conclusion PET/CT imaging with (4S)-4-(3-[18F]fluoropropyl)-l-glutamate (18F-FSPG) helped detect primary brain tumors and brain metastases with a high tumor-to-background ratio. Relative changes in 18F-FSPG uptake with multi-time-point PET appear to be helpful in predicting lesion outcomes. Clinical trial registration no. NCT02370563 © RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Mirwais Wardak
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Ida Sonni
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Audrey P Fan
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Ryogo Minamimoto
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Mehran Jamali
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Negin Hatami
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Greg Zaharchuk
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Nancy Fischbein
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Seema Nagpal
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Gordon Li
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Norman Koglin
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Mathias Berndt
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Santiago Bullich
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Andrew W Stephens
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Ludger M Dinkelborg
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Ty Abel
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - H Charles Manning
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Jarrett Rosenberg
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Frederick T Chin
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Sanjiv Sam Gambhir
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| | - Erik S Mittra
- From the Department of Radiology, Molecular Imaging Program at Stanford (MIPS) (M.W., I.S., A.P.F., R.M., M.J., N.H., G.Z., N.F., J.R., F.T.C., S.S.G., E.S.M.), Department of Neurosurgery (N.F., S.N., G.L.), and Department of Neurology and Neurological Sciences (N.F., S.N., G.L.), Stanford University School of Medicine, Stanford, Calif; Department of Molecular and Medical Pharmacology, UCLA Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif (I.S.); Department of Biomedical Engineering, Department of Neurology, University of California, Davis, Davis, Calif (A.P.F.); Stanford Bio-X (M.W., G.Z., G.L., F.T.C., S.S.G.) and Departments of Bioengineering (S.S.G.) and Materials Science & Engineering (S.S.G.), Stanford University, Stanford, Calif; Life Molecular Imaging GmbH, Berlin, Germany (N.K., M.B., S.B., A.W.S., L.M.D.); Department of Pathology, Microbiology and Immunology (T.A.) and Department of Radiology and Radiological Sciences, Institute of Imaging Science, Center for Molecular Probes (H.C.M.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (H.C.M.)
| |
Collapse
|
5
|
Czech MM, Hwang PH, Colevas AD, Fischbein N, Ho DY. Skull base osteomyelitis in patients with head and neck cancer: Diagnosis, management, and outcomes in a case series of 23 patients. Laryngoscope Investig Otolaryngol 2022; 7:47-59. [PMID: 35155783 PMCID: PMC8823154 DOI: 10.1002/lio2.719] [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: 07/14/2021] [Revised: 11/17/2021] [Accepted: 12/11/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Skull base osteomyelitis (SBO) is an infection of the central cranial bones, most commonly resulting from contiguous spread of infection from adjacent head and neck structures. SBO is a well-recognized complication of treatment of head and neck cancer (HNC) that results in significant morbidity. METHODS We conducted a retrospective chart review of HNC patients diagnosed with SBO. RESULTS SBO was commonly diagnosed with nasal endoscopy showing mucosal breakdown between the naso/oropharynx and skull base and with characteristic changes on CT/MRI. Culture data were often polymicrobial, inclusive of naso/oropharyngeal flora, but half of the patients additionally had antibiotic-resistant or atypical pathogens. The mean duration of antimicrobial therapy was 117 +/- 94 days. Recurrent SBO was found in half of the patients, associated with Pseudomonas aeruginosa and with persistent defects in the mucosa abutting the skull base. CONCLUSIONS Diagnosis and management of SBO in HNC patients are challenging. Recommendations to aid in clinical care are proposed. LEVEL OF EVIDENCE 4, case series.
Collapse
Affiliation(s)
- Mary M. Czech
- Division of Infectious Diseases and Geographic Medicine, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Peter H. Hwang
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Alexander Dimitrios Colevas
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
- Division of Medical Oncology, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Nancy Fischbein
- Department of Otolaryngology—Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
- Department of RadiologyStanford University School of MedicineStanfordCaliforniaUSA
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
- Department of NeurosurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Dora Y. Ho
- Division of Infectious Diseases and Geographic Medicine, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| |
Collapse
|
6
|
Yang Y, Fischbein N, Chukus A. Differential Diagnosis of Corpus Callosum Lesions: Beyond the Typical Butterfly Pattern. Radiographics 2021; 41:E79-E80. [PMID: 33939546 DOI: 10.1148/rg.2021200146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yi Yang
- From the Department of Radiology, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Miami, FL 33180-1407 (Y.Y., A.C.); and Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford Health Care, Stanford, Calif (N.F., A.C)
| | - Nancy Fischbein
- From the Department of Radiology, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Miami, FL 33180-1407 (Y.Y., A.C.); and Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford Health Care, Stanford, Calif (N.F., A.C)
| | - Anjeza Chukus
- From the Department of Radiology, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Miami, FL 33180-1407 (Y.Y., A.C.); and Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford Health Care, Stanford, Calif (N.F., A.C)
| |
Collapse
|
7
|
Chiu A, Fischbein N, Wintermark M, Zaharchuk G, Yun PT, Zeineh M. COVID-19-induced anosmia associated with olfactory bulb atrophy. Neuroradiology 2020; 63:147-148. [PMID: 32930820 PMCID: PMC7490479 DOI: 10.1007/s00234-020-02554-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 07/09/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022]
Abstract
As the global COVID-19 pandemic evolves, our knowledge of the respiratory and non-respiratory symptoms continues to grow. One such symptom, anosmia, may be a neurologic marker of coronavirus infection and the initial presentation of infected patients. Because this symptom is not routinely investigated by imaging, there is conflicting literature on neuroimaging abnormalities related to COVID-19-related anosmia. We present a novel case of COVID-19 anosmia with definitive olfactory bulb atrophy compared with pre-COVID imaging. The patient had prior MR imaging related to a history of prolactinoma that provided baseline volumes of her olfactory bulbs. After a positive diagnosis of COVID-19 and approximately 2 months duration of anosmia, an MRI was performed that showed clear interval olfactory bulb atrophy. This diagnostic finding is of prognostic importance and indicates that the olfactory entry point to the brain should be further investigated to improve our understanding of COVID infectious pathophysiology.
Collapse
Affiliation(s)
- Andrew Chiu
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA.
| | - Nancy Fischbein
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA
| | - Max Wintermark
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA
| | - Greg Zaharchuk
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA
| | - Paul T Yun
- Menlo Medical Clinic Stanford HealthCare, 321 Middlefield Road, 1st Floor, Menlo Park, CA, 94205, USA
| | - Michael Zeineh
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA
| |
Collapse
|
8
|
Mukherjee P, Cintra M, Huang C, Zhou M, Zhu S, Colevas AD, Fischbein N, Gevaert O. CT-based Radiomic Signatures for Predicting Histopathologic Features in Head and Neck Squamous Cell Carcinoma. Radiol Imaging Cancer 2020; 2:e190039. [PMID: 32550599 DOI: 10.1148/rycan.2020190039] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 01/08/2020] [Accepted: 01/22/2020] [Indexed: 12/15/2022]
Abstract
Purpose To determine the performance of CT-based radiomic features for noninvasive prediction of histopathologic features of tumor grade, extracapsular spread, perineural invasion, lymphovascular invasion, and human papillomavirus status in head and neck squamous cell carcinoma (HNSCC). Materials and Methods In this retrospective study, which was approved by the local institutional ethics committee, CT images and clinical data from patients with pathologically proven HNSCC from The Cancer Genome Atlas (n = 113) and an institutional test cohort (n = 71) were analyzed. A machine learning model was trained with 2131 extracted radiomic features to predict tumor histopathologic characteristics. In the model, principal component analysis was used for dimensionality reduction, and regularized regression was used for classification. Results The trained radiomic model demonstrated moderate capability of predicting HNSCC features. In the training cohort and the test cohort, the model achieved a mean area under the receiver operating characteristic curve (AUC) of 0.75 (95% confidence interval [CI]: 0.68, 0.81) and 0.66 (95% CI: 0.45, 0.84), respectively, for tumor grade; a mean AUC of 0.64 (95% CI: 0.55, 0.62) and 0.70 (95% CI: 0.47, 0.89), respectively, for perineural invasion; a mean AUC of 0.69 (95% CI: 0.56, 0.81) and 0.65 (95% CI: 0.38, 0.87), respectively, for lymphovascular invasion; a mean AUC of 0.77 (95% CI: 0.65, 0.88) and 0.67 (95% CI: 0.15, 0.80), respectively, for extracapsular spread; and a mean AUC of 0.71 (95% CI: 0.29, 1.0) and 0.80 (95% CI: 0.65, 0.92), respectively, for human papillomavirus status. Conclusion Radiomic CT models have the potential to predict characteristics typically identified on pathologic assessment of HNSCC.Supplemental material is available for this article.© RSNA, 2020.
Collapse
Affiliation(s)
- Pritam Mukherjee
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| | - Murilo Cintra
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| | - Chao Huang
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| | - Mu Zhou
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| | - Shankuan Zhu
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| | - A Dimitrios Colevas
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| | - Nancy Fischbein
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| | - Olivier Gevaert
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford, Calif (P.M., M.C., C.H., M.Z., O.G.); Department of Radiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil (M.C.); Department of Nutrition and Food Hygiene, Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Zhejiang, China (C.H., S.Z.); Division of Oncology, Department of Medicine (A.D.C.), Department of Radiology (N.F.), and Department of Biomedical Data Science (O.G.), Stanford University, 1265 Welch Rd, Stanford, CA 94305-5479
| |
Collapse
|
9
|
Hirsch KG, Fischbein N, Mlynash M, Kemp S, Bammer R, Eyngorn I, Tong J, Moseley M, Venkatasubramanian C, Caulfield AF, Albers G. Prognostic value of diffusion-weighted MRI for post-cardiac arrest coma. Neurology 2020; 94:e1684-e1692. [PMID: 32269116 DOI: 10.1212/wnl.0000000000009289] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/01/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To validate quantitative diffusion-weighted imaging (DWI) MRI thresholds that correlate with poor outcome in comatose cardiac arrest survivors, we conducted a clinician-blinded study and prospectively obtained MRIs from comatose patients after cardiac arrest. METHODS Consecutive comatose post-cardiac arrest adult patients were prospectively enrolled. MRIs obtained within 7 days after arrest were evaluated. The clinical team was blinded to the DWI MRI results and followed a prescribed prognostication algorithm. Apparent diffusion coefficient (ADC) values and thresholds differentiating good and poor outcome were analyzed. Poor outcome was defined as a Glasgow Outcome Scale score of ≤2 at 6 months after arrest. RESULTS Ninety-seven patients were included, and 75 patients (77%) had MRIs. In 51 patients with MRI completed by postarrest day 7, the prespecified threshold of >10% of brain tissue with an ADC <650 ×10-6 mm2/s was highly predictive for poor outcome with a sensitivity of 0.63 (95% confidence interval [CI] 0.42-0.80), a specificity of 0.96 (95% CI 0.77-0.998), and a positive predictive value (PPV) of 0.94 (95% CI 0.71-0.997). The mean whole-brain ADC was higher among patients with good outcomes. Receiver operating characteristic curve analysis showed that ADC <650 ×10-6 mm2/s had an area under the curve of 0.79 (95% CI 0.65-0.93, p < 0.001). Quantitative DWI MRI data improved prognostication of both good and poor outcomes. CONCLUSIONS This prospective, clinician-blinded study validates previous research showing that an ADC <650 ×10-6 mm2/s in >10% of brain tissue in an MRI obtained by postarrest day 7 is highly specific for poor outcome in comatose patients after cardiac arrest.
Collapse
Affiliation(s)
- Karen G Hirsch
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles.
| | - Nancy Fischbein
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Michael Mlynash
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Stephanie Kemp
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Roland Bammer
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Irina Eyngorn
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Julia Tong
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Michael Moseley
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Chitra Venkatasubramanian
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Anna Finley Caulfield
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| | - Gregory Albers
- From the Departments of Neurology (K.G.H., M. Mlynash, S.K., I.E., C.V., A.F.C., G.A.) and Radiology (N.F., M. Moseley), Stanford University, CA; Department of Radiology (R.B.), University of Melbourne, Parkville, VIC, Australia; and Department of Medicine (J.T.), University of California, Los Angeles
| |
Collapse
|
10
|
Wu J, Gensheimer MF, Zhang N, Guo M, Liang R, Zhang C, Fischbein N, Pollom EL, Beadle B, Le QT, Li R. Tumor Subregion Evolution-Based Imaging Features to Assess Early Response and Predict Prognosis in Oropharyngeal Cancer. J Nucl Med 2020; 61:327-336. [PMID: 31420498 PMCID: PMC7067523 DOI: 10.2967/jnumed.119.230037] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/22/2019] [Accepted: 07/29/2019] [Indexed: 12/19/2022] Open
Abstract
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been rapidly increasing. Disease stage and smoking history are often used in current clinical trials to select patients for deintensification therapy, but these features lack sufficient accuracy for predicting disease relapse. Our purpose was to develop an imaging signature to assess early response and predict outcomes of OPSCC. Methods: We retrospectively analyzed 162 OPSCC patients treated with concurrent chemoradiotherapy, equally divided into separate training and validation cohorts with similar clinical characteristics. A robust consensus clustering approach was used to spatially partition the primary tumor and involved lymph nodes into subregions (i.e., habitats) based on 18F-FDG PET and contrast CT imaging. We proposed quantitative image features to characterize the temporal volumetric change of the habitats and peritumoral/nodal tissue between baseline and midtreatment. The reproducibility of these features was evaluated. We developed an imaging signature to predict progression-free survival (PFS) by fitting an L1-regularized Cox regression model. Results: We identified 3 phenotypically distinct intratumoral habitats: metabolically active and heterogeneous, enhancing and heterogeneous, and metabolically inactive and homogeneous. The final Cox model consisted of 4 habitat evolution-based features. In both cohorts, this imaging signature significantly outperformed traditional imaging metrics, including midtreatment metabolic tumor volume for predicting PFS, with a C-index of 0.72 versus 0.67 (training) and 0.66 versus 0.56 (validation). The imaging signature stratified patients into high-risk versus low-risk groups with 2-y PFS rates of 59.1% versus 89.4% (hazard ratio, 4.4; 95% confidence interval, 1.4-13.4 [training]) and 61.4% versus 87.8% (hazard ratio, 4.6; 95% confidence interval, 1.7-12.1 [validation]). The imaging signature remained an independent predictor of PFS in multivariable analysis adjusting for stage, human papillomavirus status, and smoking history. Conclusion: The proposed imaging signature allows more accurate prediction of disease progression and, if prospectively validated, may refine OPSCC patient selection for risk-adaptive therapy.
Collapse
Affiliation(s)
- Jia Wu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Nasha Zhang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Meiying Guo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Rachel Liang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Carrie Zhang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Nancy Fischbein
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| |
Collapse
|
11
|
Lu G, Fakurnejad S, Martin BA, van den Berg NS, van Keulen S, Nishio N, Zhu AJ, Chirita SU, Zhou Q, Gao RW, Kong CS, Fischbein N, Penta M, Colevas AD, Rosenthal EL. Predicting Therapeutic Antibody Delivery into Human Head and Neck Cancers. Clin Cancer Res 2020; 26:2582-2594. [PMID: 31980465 DOI: 10.1158/1078-0432.ccr-19-3717] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 01/21/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The efficacy of antibody-based therapeutics depends on successful drug delivery into solid tumors; therefore, there is a clinical need to measure intratumoral antibody distribution. This study aims to develop and validate an imaging and computation platform to directly quantify and predict antibody delivery into human head and neck cancers in a clinical study. EXPERIMENTAL DESIGN Twenty-four patients received systemic infusion of a near-infrared fluorescence-labeled therapeutic antibody followed by surgical tumor resection. A computational platform was developed to quantify the extent of heterogeneity of intratumoral antibody distribution. Both univariate and multivariate regression analyses were used to select the most predictive tumor biological factors for antibody delivery. Quantitative image features from the pretreatment MRI were extracted and correlated with fluorescence imaging of antibody delivery. RESULTS This study not only confirmed heterogeneous intratumoral antibody distribution in-line with many preclinical reports, but also quantified the extent of interpatient, intertumor, and intratumor heterogeneity of antibody delivery. This study demonstrated the strong predictive value of tumor size for intratumoral antibody accumulation and its significant impact on antibody distribution in both primary tumor and lymph node metastasis. Furthermore, this study established the feasibility of using contrast-enhanced MRI to predict antibody delivery. CONCLUSIONS This study provides a clinically translatable platform to measure antibody delivery into solid tumors and yields valuable insight into clinically relevant antibody tumor penetration, with implications in the selection of patients amenable to antibody therapy and the design of more effective dosing strategies.
Collapse
Affiliation(s)
- Guolan Lu
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | | | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Nynke S van den Berg
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Stan van Keulen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Naoki Nishio
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Ashley J Zhu
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Stefania U Chirita
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Quan Zhou
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Rebecca W Gao
- Stanford University School of Medicine, Stanford, California
| | - Christina S Kong
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Nancy Fischbein
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Mrudula Penta
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Alexander D Colevas
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Eben L Rosenthal
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California. .,Department of Radiology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
12
|
Turner BE, Prabhu RS, Burri SH, Brown PD, Pollom EL, Milano MT, Weiss SE, Iv M, Fischbein N, Soliman H, Lo SS, Chao ST, Cox BW, Murphy JD, Li G, Gephart MH, Nagpal S, Atalar B, Azoulay M, Thomas R, Tillman G, Durkee BY, Shah JL, Soltys SG. Nodular Leptomeningeal Disease-A Distinct Pattern of Recurrence After Postresection Stereotactic Radiosurgery for Brain Metastases: A Multi-institutional Study of Interobserver Reliability. Int J Radiat Oncol Biol Phys 2019; 106:579-586. [PMID: 31605786 DOI: 10.1016/j.ijrobp.2019.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE For brain metastases, surgical resection with postoperative stereotactic radiosurgery is an emerging standard of care. Postoperative cavity stereotactic radiosurgery is associated with a specific, underrecognized pattern of intracranial recurrence, herein termed nodular leptomeningeal disease (nLMD), which is distinct from classical leptomeningeal disease. We hypothesized that there is poor consensus regarding the definition of LMD, and that a formal, self-guided training module will improve interrater reliability (IRR) and validity in diagnosing LMD. METHODS AND MATERIALS Twenty-two physicians at 16 institutions, including 15 physicians with central nervous system expertise, completed a 2-phase survey that included magnetic resonance imaging and treatment information for 30 patients. In the "pretraining" phase, physicians labeled cases using 3 patterns of recurrence commonly reported in prospective studies: local recurrence (LR), distant parenchymal recurrence (DR), and LMD. After a self-directed training module, participating physicians completed the "posttraining" phase and relabeled the 30 cases using the 4 following labels: LR, DR, classical leptomeningeal disease, and nLMD. RESULTS IRR increased 34% after training (Fleiss' Kappa K = 0.41 to K = 0.55, P < .001). IRR increased most among non-central nervous system specialists (+58%, P < .001). Before training, IRR was lowest for LMD (K = 0.33). After training, IRR increased across all recurrence subgroups and increased most for LMD (+67%). After training, ≥27% of cases initially labeled LR or DR were later recognized as nLMD. CONCLUSIONS This study highlights the large degree of inconsistency among clinicians in recognizing nLMD. Our findings demonstrate that a brief self-guided training module distinguishing nLMD can significantly improve IRR across all patterns of recurrence, and particularly in nLMD. To optimize outcomes reporting, prospective trials in brain metastases should incorporate central imaging review and investigator training.
Collapse
Affiliation(s)
- Brandon E Turner
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Roshan S Prabhu
- Southeast Radiation Oncology Group, Charlotte, North Carolina; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Stuart H Burri
- Southeast Radiation Oncology Group, Charlotte, North Carolina; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | | | | | - Michael Iv
- Department of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - Nancy Fischbein
- Department of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Brett W Cox
- Department of Radiation Medicine, Northwell Health, New York, New York
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Gordon Li
- Department of Neurosurgery, Stanford School of Medicine, Stanford, California
| | | | - Seema Nagpal
- Department of Neurology, Stanford University, Stanford, California
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Melissa Azoulay
- Department of Radiation Oncology, McGill University Health Center, Montreal, Canada
| | - Reena Thomas
- Department of Neurology, Stanford University, Stanford, California
| | - Gayle Tillman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ben Y Durkee
- Department of Radiation Oncology, SwedishAmerican, Rockford, Illinois
| | - Jennifer L Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California.
| |
Collapse
|
13
|
Iv M, Liu X, Lavezo J, Gentles AJ, Ghanem R, Lummus S, Born DE, Soltys SG, Nagpal S, Thomas R, Recht L, Fischbein N. Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making. AJNR Am J Neuroradiol 2019; 40:1649-1657. [PMID: 31515215 DOI: 10.3174/ajnr.a6211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Fractional tumor burden better correlates with histologic tumor volume fraction in treated glioblastoma than other perfusion metrics such as relative CBV. We defined fractional tumor burden classes with low and high blood volume to distinguish tumor from treatment effect and to determine whether fractional tumor burden can inform treatment-related decision-making. MATERIALS AND METHODS Forty-seven patients with high-grade gliomas (primarily glioblastoma) with recurrent contrast-enhancing lesions on DSC-MR imaging were retrospectively evaluated after surgical sampling. Histopathologic examination defined treatment effect versus tumor. Normalized relative CBV thresholds of 1.0 and 1.75 were used to define low, intermediate, and high fractional tumor burden classes in each histopathologically defined group. Performance was assessed with an area under the receiver operating characteristic curve. Consensus agreement among physician raters reporting hypothetic changes in treatment-related decisions based on fractional tumor burden was compared with actual real-time treatment decisions. RESULTS Mean lower fractional tumor burden, high fractional tumor burden, and relative CBV of the contrast-enhancing volume were significantly different between treatment effect and tumor (P = .002, P < .001, and P < .001), with tumor having significantly higher fractional tumor burden and relative CBV and lower fractional tumor burden. No significance was found with intermediate fractional tumor burden. Performance of the area under the receiver operating characteristic curve was the following: high fractional tumor burden, 0.85; low fractional tumor burden, 0.7; and relative CBV, 0.81. In comparing treatment decisions, there were disagreements in 7% of tumor and 44% of treatment effect cases; in the latter, all disagreements were in cases with scattered atypical cells. CONCLUSIONS High fractional tumor burden and low fractional tumor burden define fractions of the contrast-enhancing lesion volume with high and low blood volume, respectively, and can differentiate treatment effect from tumor in recurrent glioblastomas. Fractional tumor burden maps can also help to inform clinical decision-making.
Collapse
Affiliation(s)
- M Iv
- From the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
| | - X Liu
- Department of Neurosurgery (X.L.), Shengjing Hospital of China Medical University, Shenyang, China
| | - J Lavezo
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - A J Gentles
- Medicine (Biomedical Informatics Research) (A.J.G.)
| | - R Ghanem
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - S Lummus
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - D E Born
- Pathology (J.L., R.G., S.L., D.E.B.)
| | | | - S Nagpal
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - R Thomas
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - L Recht
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - N Fischbein
- From the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
| |
Collapse
|
14
|
Amukotuwa S, Straka M, Aksoy D, Fischbein N, Desmond P, Albers G, Bammer R. Cerebral Blood Flow Predicts the Infarct Core: New Insights From Contemporaneous Diffusion and Perfusion Imaging. Stroke 2019; 50:2783-2789. [PMID: 31462191 DOI: 10.1161/strokeaha.119.026640] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 01/01/2023]
Abstract
Background and Purpose- The aim of this study is to determine the spatial and volumetric accuracy of infarct core estimates from relative cerebral blood flow (rCBF) by comparison with near-contemporaneous diffusion-weighted imaging (DWI), and evaluate whether it is sufficient for patient triage to reperfusion therapies. Methods- One hundred ninety-three patients enrolled in the DEFUSE 2 (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution) and SENSE 3 (Sensitivity Encoding) stroke studies were screened, and 119 who underwent acute magnetic resonance imaging with DWI and perfusion imaging within 24 hours of onset were included. Infarct core was estimated using reduced rCBF at 12 thresholds (<0.20-<0.44) and compared against DWI (apparent diffusion coefficient <620 10-6mm2/s). For each threshold, volumetric agreement between the rCBF and DWI core estimates was assessed using Bland-Altman, correlation, and linear regression analyses; spatial agreement was assessed using receiver operating characteristic analysis. Results- An rCBF threshold of 0.32 yielded the smallest mean absolute volume difference (14.7 mL), best linear regression fit (R2=0.84), and best spatial agreement (Youden index, 0.38; 95% CI, 0.34-0.41) between rCBF and DWI, with high correlation (r=0.91, P<0.05), a small mean volume difference (1.3 mL) and no fixed bias (P<0.05). At this threshold, 110 of 119 (92.4%) patients were correctly triaged when applying 70 mL as the volume limit for thrombectomy. Spatial agreement was better for prediction of large infarcts (>70 mL) than small infarcts (≤70 mL), with Youden indices of 0.53 (95% CI, 0.49-0.56) and 0.34 (95% CI, 0.30-0.37), respectively. Conclusions- Strong correlation and agreement with near-contemporaneous DWI indicate that infarct core estimates obtained using rCBF are sufficiently accurate for patient triage to reperfusion therapies. The identified optimal rCBF threshold of 0.32 closely approximates the threshold currently used in clinical practice.
Collapse
Affiliation(s)
- Shalini Amukotuwa
- From the Department of Radiology (S.A.), University of Melbourne, Australia
| | - Matus Straka
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA (M.S., D.A., G.A.)
| | - Didem Aksoy
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA (M.S., D.A., G.A.)
| | | | - Patricia Desmond
- Department of Radiology (P.D.), University of Melbourne, Australia
| | - Gregory Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA (M.S., D.A., G.A.)
| | - Roland Bammer
- Department of Radiology and Florey Department of Neuroscience and Mental Health (R.B.), University of Melbourne, Australia
| |
Collapse
|
15
|
Wu J, Gensheimer MF, Zhang N, Han F, Liang R, Qian Y, Zhang C, Fischbein N, Pollom EL, Beadle B, Le QT, Li R. Integrating Tumor and Nodal Imaging Characteristics at Baseline and Mid-Treatment Computed Tomography Scans to Predict Distant Metastasis in Oropharyngeal Cancer Treated With Concurrent Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2019; 104:942-952. [PMID: 30940529 PMCID: PMC6579673 DOI: 10.1016/j.ijrobp.2019.03.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/19/2018] [Revised: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Prognostic biomarkers of disease relapse are needed for risk-adaptive therapy of oropharyngeal cancer (OPC). This work aims to identify an imaging signature to predict distant metastasis in OPC. METHODS AND MATERIALS This single-institution retrospective study included 140 patients treated with definitive concurrent chemoradiotherapy, for whom both pre- and midtreatment contrast-enhanced computed tomography (CT) scans were available. Patients were divided into separate training and testing cohorts. Forty-five quantitative image features were extracted to characterize tumor and involved lymph nodes at both time points. By incorporating both imaging and clinicopathological features, a random survival forest (RSF) model was built to predict distant metastasis-free survival (DMFS). The model was optimized via repeated cross-validation in the training cohort and then independently validated in the testing cohort. RESULTS The most important features for predicting DMFS were the maximum distance among nodes, maximum distance between tumor and nodes at mid-treatment, and pretreatment tumor sphericity. In the testing cohort, the RSF model achieved good discriminability for DMFS (C-index = 0.73, P = .008), and further divided patients into 2 risk groups with different 2-year DMFS rates: 96.7% versus 67.6%. Similar trends were observed for patients with p16+ tumors and smoking ≤10 pack-years. The RSF model based on pretreatment CT features alone achieved lower performance (concordance index = 0.68, P = .03). CONCLUSIONS Integrating tumor and nodal imaging characteristics at baseline and mid-treatment CT allows prediction of distant metastasis in OPC. The proposed imaging signature requires prospective validation and, if successful, may help identify high-risk human papillomavirus-positive patients who should not be considered for deintensification therapy.
Collapse
Affiliation(s)
- Jia Wu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Micheal F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Nasha Zhang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Rachel Liang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Yushen Qian
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Carrie Zhang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Nancy Fischbein
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
16
|
Huang C, Cintra M, Brennan K, Zhou M, Colevas AD, Fischbein N, Zhu S, Gevaert O. Development and validation of radiomic signatures of head and neck squamous cell carcinoma molecular features and subtypes. EBioMedicine 2019; 45:70-80. [PMID: 31255659 PMCID: PMC6642281 DOI: 10.1016/j.ebiom.2019.06.034] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [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: 03/19/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Radiomics-based non-invasive biomarkers are promising to facilitate the translation of therapeutically related molecular subtypes for treatment allocation of patients with head and neck squamous cell carcinoma (HNSCC). METHODS We included 113 HNSCC patients from The Cancer Genome Atlas (TCGA-HNSCC) project. Molecular phenotypes analyzed were RNA-defined HPV status, five DNA methylation subtypes, four gene expression subtypes and five somatic gene mutations. A total of 540 quantitative image features were extracted from pre-treatment CT scans. Features were selected and used in a regularized logistic regression model to build binary classifiers for each molecular subtype. Models were evaluated using the average area under the Receiver Operator Characteristic curve (AUC) of a stratified 10-fold cross-validation procedure repeated 10 times. Next, an HPV model was trained with the TCGA-HNSCC, and tested on a Stanford cohort (N = 53). FINDINGS Our results show that quantitative image features are capable of distinguishing several molecular phenotypes. We obtained significant predictive performance for RNA-defined HPV+ (AUC = 0.73), DNA methylation subtypes MethylMix HPV+ (AUC = 0.79), non-CIMP-atypical (AUC = 0.77) and Stem-like-Smoking (AUC = 0.71), and mutation of NSD1 (AUC = 0.73). We externally validated the HPV prediction model (AUC = 0.76) on the Stanford cohort. When compared to clinical models, radiomic models were superior to subtypes such as NOTCH1 mutation and DNA methylation subtype non-CIMP-atypical while were inferior for DNA methylation subtype CIMP-atypical and NSD1 mutation. INTERPRETATION Our study demonstrates that radiomics can potentially serve as a non-invasive tool to identify treatment-relevant subtypes of HNSCC, opening up the possibility for patient stratification, treatment allocation and inclusion in clinical trials. FUND: Dr. Gevaert reports grants from National Institute of Dental & Craniofacial Research (NIDCR) U01 DE025188, grants from National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health (NIBIB), R01 EB020527, grants from National Cancer Institute (NCI), U01 CA217851, during the conduct of the study; Dr. Huang and Dr. Zhu report grants from China Scholarship Council (Grant NO:201606320087), grants from China Medical Board Collaborating Program (Grant NO:15-216), the Cyrus Tang Foundation, and the Zhejiang University Education Foundation during the conduct of the study; Dr. Cintra reports grants from São Paulo State Foundation for Teaching and Research (FAPESP), during the conduct of the study.
Collapse
Affiliation(s)
- Chao Huang
- Chronic Disease Research Institute, School of Public Health, and Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, Hangzhou, China; Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Zhejiang, Hangzhou, China; Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), USA
| | - Murilo Cintra
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), USA; Department of Radiology, Stanford University, USA; Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Kevin Brennan
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), USA
| | - Mu Zhou
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), USA
| | | | | | - Shankuan Zhu
- Chronic Disease Research Institute, School of Public Health, and Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, Hangzhou, China; Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Zhejiang, Hangzhou, China.
| | - Olivier Gevaert
- Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), USA; Department of Biomedical Data Science, Stanford University, USA.
| |
Collapse
|
17
|
Turner B, Prabhu R, Burri S, Brown P, Pollom E, Milano M, Weiss S, Iv M, Fischbein N, Soliman H, Lo S, Soltys S. Nodular Leptomeningeal Disease – A Distinct Pattern of Recurrence after Post-Resection Stereotactic Radiosurgery for Brain Metastases: A Multi-Institutional Study of Inter-Observer Reliability. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
18
|
Lamsam L, Quon J, Fischbein N, Iv M, Dodd R, Ratliff J. Conus Medullaris Dural Arteriovenous Fistula Arising From the Artery of the Filum Terminale: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2018; 15:471. [PMID: 29444295 DOI: 10.1093/ons/opx297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Layton Lamsam
- Stanford University School of Medicine, Stanford, California
| | - Jennifer Quon
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Nancy Fischbein
- Department of Radiology, Stanford University, Stanford, California
| | - Michael Iv
- Department of Radiology, Stanford University, Stanford, California
| | - Robert Dodd
- Department of Neurosurgery, Stanford University, Stanford, California
| | - John Ratliff
- Department of Neurosurgery, Stanford University, Stanford, California
| |
Collapse
|
19
|
Chan C, Iv M, Fischbein N, Dahmoush H. Lobular capillary hemangioma of the mandible: A case report. Clin Imaging 2018; 50:246-249. [DOI: 10.1016/j.clinimag.2018.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/03/2018] [Accepted: 04/12/2018] [Indexed: 11/15/2022]
|
20
|
Kang JH, Buckley AF, Nagpal S, Fischbein N, Peters KB. A Diffuse Leptomeningeal Glioneuronal Tumor Without Diffuse Leptomeningeal Involvement: Detailed Molecular and Clinical Characterization. J Neuropathol Exp Neurol 2018; 77:751-756. [DOI: 10.1093/jnen/nly053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jennifer H Kang
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Anne F Buckley
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Seema Nagpal
- Department of Neurology, Stanford University Medical Center, Palo Alto, California
| | - Nancy Fischbein
- Department of Radiology, Stanford University Medical Center, Palo Alto, California
| | - Katherine B Peters
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
21
|
Amukotuwa SA, Marks MP, Zaharchuk G, Calamante F, Bammer R, Fischbein N. Arterial Spin-Labeling Improves Detection of Intracranial Dural Arteriovenous Fistulas with MRI. AJNR Am J Neuroradiol 2018; 39:669-677. [PMID: 29545245 DOI: 10.3174/ajnr.a5570] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 12/26/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial dural arteriovenous fistulas carry a risk of substantial neurologic complications but can be difficult to detect on structural MR imaging and TOF-MRA. The purpose of this study was to assess the accuracy and added value of 3D pseudocontinuous arterial spin-labeling MR imaging for the detection of these lesions. MATERIALS AND METHODS This retrospective study included 39 patients with a dural arteriovenous fistula and 117 controls who had undergone both DSA and MR imaging with pseudocontinuous arterial spin-labeling. Two neuroradiologists blinded to the DSA results independently assessed MR imaging with and without pseudocontinuous arterial spin-labeling. They recorded specific signs, including venous arterial spin-labeling signal, and the likelihood of a dural arteriovenous fistula using a 5-point Likert scale. Logistic regression and receiver operating characteristic analyses were performed to determine the accuracy of specific signs and the added value of pseudocontinuous arterial spin-labeling. Interobserver agreement was determined by using κ statistics. RESULTS Identification of the venous arterial spin-labeling signal had a high sensitivity (94%) and specificity (88%) for the presence a dural arteriovenous fistula. Receiver operating characteristic analysis showed significant improvement in diagnostic performance with the addition of pseudocontinuous arterial spin-labeling in comparison with structural MR imaging (Δarea under the receiver operating characteristic curve = 0.179) and a trend toward significant improvement in comparison with structural MR imaging with time-of-flight MRA (Δarea under the receiver operating characteristic curve = 0.043). Interobserver agreement for the presence of a dural arteriovenous fistula improved substantially and was almost perfect with the addition of pseudocontinuous arterial spin-labeling (κ = 0.92). CONCLUSIONS Venous arterial spin-labeling signal has high sensitivity and specificity for the presence of a dural arteriovenous fistula, and the addition of pseudocontinuous arterial spin-labeling increases confidence in the diagnosis of this entity on MR imaging.
Collapse
Affiliation(s)
- S A Amukotuwa
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
- Florey Department of Neuroscience and Mental Health (S.A.A., F.C.), University of Melbourne, Melbourne, Victoria, Australia
| | - M P Marks
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
| | - G Zaharchuk
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
| | - F Calamante
- Florey Department of Neuroscience and Mental Health (S.A.A., F.C.), University of Melbourne, Melbourne, Victoria, Australia
| | - R Bammer
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
| | - N Fischbein
- From the Department of Radiology (S.A.A., M.P.M., G.Z., R.B., N.F.), Stanford University, Stanford, California
| |
Collapse
|
22
|
Iv M, Yoon BC, Heit JJ, Fischbein N, Wintermark M. Current Clinical State of Advanced Magnetic Resonance Imaging for Brain Tumor Diagnosis and Follow Up. Semin Roentgenol 2018; 53:45-61. [DOI: 10.1053/j.ro.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Ma M, Chen JY, Plowey ED, Fischbein N, Iv M. Tumefactive demyelination associated with developmental venous anomaly: Report of two cases. Clin Imaging 2017; 43:194-198. [PMID: 28364723 DOI: 10.1016/j.clinimag.2017.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/25/2017] [Indexed: 11/18/2022]
Abstract
We present two cases of tumefactive demyelination (TD) occurring in close association with a developmental venous anomaly (DVA). Our purpose is to describe the association between demyelinating lesions and venous anomalies, as only one case of TD associated with a DVA has been published in the literature. Appropriate recognition of this "do not touch" lesion may avoid invasive and potentially harmful procedures such as biopsy or resection.
Collapse
Affiliation(s)
- Mingming Ma
- Department of Radiology, Stanford University Medical Center, Stanford, CA, United States.
| | - James Y Chen
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Edward D Plowey
- Department of Pathology, Stanford University Medical Center, Stanford, CA, United States
| | - Nancy Fischbein
- Department of Radiology, Stanford University Medical Center, Stanford, CA, United States
| | - Michael Iv
- Department of Radiology, Stanford University Medical Center, Stanford, CA, United States
| |
Collapse
|
24
|
Schultz R, Steven A, Wessell A, Fischbein N, Sansur CA, Gandhi D, Ibrahimi D, Raghavan P. Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography. J Neurosurg Spine 2017; 26:754-759. [DOI: 10.3171/2016.11.spine16696] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVEDorsal arachnoid webs (DAWs) and spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. Differentiating these 2 entities on the basis of clinical presentation and radiological findings remains challenging but is of vital importance in planning a surgical approach. The authors examined the differences between DAWs and idiopathic SCH on MRI and CT myelography to improve diagnostic confidence prior to surgery.METHODSReview of the picture archiving and communication system (PACS) database between 2005 and 2015 identified 6 patients with DAW and 5 with SCH. Clinical data including demographic information, presenting symptoms and neurological signs, and surgical reports were collected from the electronic medical records. Ten of the 11 patients underwent MRI. CT myelography was performed in 3 patients with DAW and in 1 patient with SCH. Imaging studies were analyzed by 2 board-certified neuroradiologists for the following features: 1) location of the deformity; 2) presence or absence of cord signal abnormality or syringomyelia; 3) visible arachnoid web; 4) presence of a dural defect; 5) nature of dorsal cord indentation (abrupt “scalpel sign” vs “C”-shaped); 6) focal ventral cord kink; 7) presence of the nuclear trail sign (endplate irregularity, sclerosis, and/or disc-space calcification that could suggest a migratory path of a herniated disc); and 8) visualization of a complete plane of CSF ventral to the deformity.RESULTSThe scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified.CONCLUSIONSDAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of the ventral subarachnoid space at the level of the cord deformity.
Collapse
Affiliation(s)
- Randall Schultz
- Departments of 1Diagnostic Radiology and Nuclear Medicine, and
| | - Andrew Steven
- Departments of 1Diagnostic Radiology and Nuclear Medicine, and
| | - Aaron Wessell
- 2Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland; and
| | - Nancy Fischbein
- 3Department of Radiology, Stanford University, Stanford, California
| | - Charles A. Sansur
- 2Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland; and
| | - Dheeraj Gandhi
- Departments of 1Diagnostic Radiology and Nuclear Medicine, and
| | - David Ibrahimi
- 2Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland; and
| | | |
Collapse
|
25
|
Wintermark M, Zeineh M, Zaharchuk G, Srivastava A, Fischbein N. Non-Relative Value Unit-Generating Activities Represent One-Fifth of Academic Neuroradiologist Productivity. AJNR Am J Neuroradiol 2016; 37:1206-8. [PMID: 26939630 DOI: 10.3174/ajnr.a4701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/14/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A neuroradiologist's activity includes many tasks beyond interpreting relative value unit-generating imaging studies. Our aim was to test a simple method to record and quantify the non-relative value unit-generating clinical activity represented by consults and clinical conferences, including tumor boards. MATERIALS AND METHODS Four full-time neuroradiologists, working an average of 50% clinical and 50% academic activity, systematically recorded all the non-relative value unit-generating consults and conferences in which they were involved during 3 months by using a simple, Web-based, computer-based application accessible from smartphones, tablets, or computers. The number and type of imaging studies they interpreted during the same period and the associated relative value units were extracted from our billing system. RESULTS During 3 months, the 4 neuroradiologists working an average of 50% clinical activity interpreted 4241 relative value unit-generating imaging studies, representing 8152 work relative value units. During the same period, they recorded 792 non-relative value unit-generating study reviews as part of consults and conferences (not including reading room consults), representing 19% of the interpreted relative value unit-generating imaging studies. CONCLUSIONS We propose a simple Web-based smartphone app to record and quantify non-relative value unit-generating activities including consults, clinical conferences, and tumor boards. The quantification of non-relative value unit-generating activities is paramount in this time of a paradigm shift from volume to value. It also represents an important tool for determining staffing levels, which cannot be performed on the basis of relative value unit only, considering the importance of time spent by radiologists on non-relative value unit-generating activities. It may also influence payment models from medical centers to radiology departments or practices.
Collapse
Affiliation(s)
- M Wintermark
- From the Departments of Radiology (M.W., M.Z., G.Z., N.F.)
| | - M Zeineh
- From the Departments of Radiology (M.W., M.Z., G.Z., N.F.)
| | - G Zaharchuk
- From the Departments of Radiology (M.W., M.Z., G.Z., N.F.)
| | - A Srivastava
- Neuroradiology Section, and Radiology (A.S.), Stanford University, Stanford, California
| | - N Fischbein
- From the Departments of Radiology (M.W., M.Z., G.Z., N.F.)
| |
Collapse
|
26
|
Iagaru A, Mosci C, Mittra E, Zaharchuk G, Fischbein N, Harsh G, Li G, Nagpal S, Recht L, Gambhir SS. Glioblastoma Multiforme Recurrence: An Exploratory Study of (18)F FPPRGD2 PET/CT. Radiology 2016; 280:328. [PMID: 27322985 DOI: 10.1148/radiol.2016164020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
27
|
Hobbs K, Stern-Nezer S, Buckwalter MS, Fischbein N, Finley Caulfield A. Metronidazole-induced encephalopathy: not always a reversible situation. Neurocrit Care 2016; 22:429-36. [PMID: 25561434 DOI: 10.1007/s12028-014-0102-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Metronidazole is a nitroimidazole antimicrobial drug prescribed to treat infections caused by anaerobic bacteria and protozoa. Uncommonly, it causes central nervous system (CNS) toxicity manifesting as metronidazole-induced encephalopathy (MIE). METHODS Case report. RESULTS A 65-year-old woman with hepatitis B cirrhosis (Child-Pugh class C, MELD 21) developed progressive encephalopathy to GCS 4 during a 3-week course of metronidazole for cholecystitis. Initial MRI was consistent with CNS metronidazole toxicity, with symmetrical T2 hyperintensity and generally restricted diffusion in bilateral dentate nuclei, corpus callosum, midbrain, superior cerebellar peduncles, internal capsules, and cerebral white matter. Laboratory values did not demonstrate significant electrolyte shifts, and continuous EEG was without seizure. High-dose thiamine was empirically administered. Lumbar puncture was not performed due to coagulopathy and thrombocytopenia. Despite discontinuation of metronidazole and keeping ammonia levels near normal, the patient did not improve. MRI was repeated 1 week after discontinuation of metronidazole. Although there was decreased DWI hyperintensity in the dentate nuclei, diffuse T2 hyperintensity persisted and even progressed in the brainstem, basal ganglia, and subcortical white matter. Petechial hemorrhages developed in bilateral corticospinal tracts and subcortical white matter. T1 hypointensity appeared in the corpus callosum. She was transitioned to comfort measures only and died 12 days later. CONCLUSION MIE is an uncommon adverse effect of treatment with metronidazole that characteristically affects the dentate nuclei but may also involve the brainstem, corpus callosum, subcortical white matter, and basal ganglia. While the clinical symptoms and neuroimaging changes are usually reversible, persistent encephalopathy with poor outcome may occur.
Collapse
Affiliation(s)
- Kyle Hobbs
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, 300 Pasteur Drive, MC 5778, Stanford, CA, 94305, USA
| | | | | | | | | |
Collapse
|
28
|
Hiniker SM, Modlin LA, Choi CY, Atalar B, Seiger K, Binkley MS, Harris JP, Liao YJ, Fischbein N, Wang L, Ho A, Lo A, Chang SD, Harsh GR, Gibbs IC, Hancock SL, Li G, Adler JR, Soltys SG. Dose-Response Modeling of the Visual Pathway Tolerance to Single-Fraction and Hypofractionated Stereotactic Radiosurgery. Semin Radiat Oncol 2016; 26:97-104. [DOI: 10.1016/j.semradonc.2015.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
29
|
Abstract
The development of new imaging techniques coupled with new treatment algorithms has created new possibilities in treating temporal bone diseases. This article provides an overview of recent imaging innovations that can be applied to temporal bone diseases. Topics covered include the role of magnetic resonance (MR) diffusion-weighted imaging in cholesteatomas and skull base epidermoids, whole-body molecular imaging in paragangliomas of the jugular foramen, and MR arterial spin labeling perfusion for dural arteriovenous fistulas and arteriovenous malformations.
Collapse
Affiliation(s)
- C Eduardo Corrales
- Department of Otology, Neurotology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Nancy Fischbein
- Departments of Radiology, Otolaryngology-Head and Neck Surgery, Neurology, Neurosurgery and Radiation Oncology, Stanford University Medical Center, 300 Pasteur Drive, Room S-047, Stanford, CA 94305, USA
| | - Robert K Jackler
- Division of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
| |
Collapse
|
30
|
Iagaru A, Mosci C, Mittra E, Zaharchuk G, Fischbein N, Harsh G, Li G, Nagpal S, Recht L, Gambhir SS. Glioblastoma Multiforme Recurrence: An Exploratory Study of (18)F FPPRGD2 PET/CT. Radiology 2015; 277:497-506. [PMID: 25965900 DOI: 10.1148/radiol.2015141550] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To prospectively evaluate fluorine 18 ((18)F) 2-fluoropropionyl-labeled PEGylated dimeric arginine-glycine-aspartic acid (RGD) peptide (PEG3-E[c{RGDyk}]2) (FPPRGD2) positron emission tomography (PET) in patients with glioblastoma multiforme (GBM). MATERIALS AND METHODS The institutional review board approved this HIPAA-compliant protocol. Written informed consent was obtained from each patient. (18)F FPPRGD2 uptake was measured semiquantitatively in the form of maximum standardized uptake values (SUV(max)) and uptake volumes before and after treatment with bevacizumab. Vital signs and laboratory results were collected before, during, and after the examinations. A nonparametric version of multivariate analysis of variance was used to assess safety outcome measures simultaneously across time points. A paired two-sample t test was performed to compare SUV(max). RESULTS A total of 17 participants (eight men, nine women; age range, 25-65 years) were enrolled prospectively. (18)F FPPRGD2 PET/computed tomography (CT), (18)F fluorodeoxyglucose (FDG) PET/CT, and brain magnetic resonance (MR) imaging were performed within 3 weeks, prior to the start of bevacizumab therapy. In eight of the 17 patients (47%), (18)F FPPRGD2 PET/CT was repeated 1 week after the start of bevacizumab therapy; six patients (35%) underwent (18)F FPPRGD2 PET/CT a third time 6 weeks after starting bevacizumab therapy. There were no changes in vital signs, electrocardiographic findings, or laboratory values that qualified as adverse events. One patient (6%) had recurrent GBM identified only on (18)F FPPRGD2 PET images, and subsequent MR images enabled confirmation of recurrence. Of the 17 patients, 14 (82%) had recurrent GBM identified on (18)F FPPRGD2 PET and brain MR images, while (18)F FDG PET enabled identification of recurrence in 13 (76%) patients. Two patients (12%) had no recurrent GBM. CONCLUSION (18)F FPPRGD2 is a safe PET radiopharmaceutical that has increased uptake in GBM lesions. Larger cohorts are required to confirm these preliminary findings.
Collapse
Affiliation(s)
- Andrei Iagaru
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Camila Mosci
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Erik Mittra
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Greg Zaharchuk
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Nancy Fischbein
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Griffith Harsh
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Gordon Li
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Seema Nagpal
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Lawrence Recht
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| | - Sanjiv Sam Gambhir
- From the Division of Nuclear Medicine and Molecular Imaging (A.I., C.M., E.M.), Department of Radiology, Neuroradiology Section (G.Z., N.F.), Division of Neurosurgery (G.H., G.L.), and Division of Neuro Oncology (S.N., L.R.), Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA 94305; and Departments of Radiology, Bioengineering, Materials Science, and Engineering, Stanford University School of Medicine, Stanford, Calif (S.S.G.)
| |
Collapse
|
31
|
Maclaren J, Han Z, Vos SB, Fischbein N, Bammer R. Reliability of brain volume measurements: a test-retest dataset. Sci Data 2014; 1:140037. [PMID: 25977792 PMCID: PMC4411010 DOI: 10.1038/sdata.2014.37] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [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: 03/21/2014] [Accepted: 09/02/2014] [Indexed: 01/18/2023] Open
Abstract
Evaluation of neurodegenerative disease progression may be assisted by quantification of the volume of structures in the human brain using magnetic resonance imaging (MRI). Automated segmentation software has improved the feasibility of this approach, but often the reliability of measurements is uncertain. We have established a unique dataset to assess the repeatability of brain segmentation and analysis methods. We acquired 120 T1-weighted volumes from 3 subjects (40 volumes/subject) in 20 sessions spanning 31 days, using the protocol recommended by the Alzheimer's Disease Neuroimaging Initiative (ADNI). Each subject was scanned twice within each session, with repositioning between the two scans, allowing determination of test-retest reliability both within a single session (intra-session) and from day to day (inter-session). To demonstrate the application of the dataset, all 3D volumes were processed using FreeSurfer v5.1. The coefficient of variation of volumetric measurements was between 1.6% (caudate) and 6.1% (thalamus). Inter-session variability exceeded intra-session variability for lateral ventricle volume (P<0.0001), indicating that ventricle volume in the subjects varied between days.
Collapse
Affiliation(s)
- Julian Maclaren
- Center for Quantitative Neuroimaging, Department of Radiology, Stanford University, Stanford, California 94305, USA
| | - Zhaoying Han
- Center for Quantitative Neuroimaging, Department of Radiology, Stanford University, Stanford, California 94305, USA
| | - Sjoerd B Vos
- Center for Quantitative Neuroimaging, Department of Radiology, Stanford University, Stanford, California 94305, USA
- Image Sciences Institute, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nancy Fischbein
- Center for Quantitative Neuroimaging, Department of Radiology, Stanford University, Stanford, California 94305, USA
| | - Roland Bammer
- Center for Quantitative Neuroimaging, Department of Radiology, Stanford University, Stanford, California 94305, USA
| |
Collapse
|
32
|
Abstract
Imaging of the skull base presents many challenges due to its anatomical complexity, numerous normal variants and lack of familiarity to many radiologists. As the skull base is a region which is not amenable to physical examination and as lesions of the skull base are generally difficult to biopsy and even more difficult to operate on, the radiologist plays a major role in directing patient management via accurate image interpretation. Knowledge of the skull base should not be limited to neuroradiologists and head and neck radiologists, however, as the central skull base is routinely included in the field of view when imaging the brain, cervical spine, or head and neck with computed tomography or magnetic resonance imaging, and hence, its nuances should be familiar to general radiologists as well. We herein review the imaging findings of a subcategory of lesions of the central skull base, the 'do not touch' lesions.
Collapse
Affiliation(s)
- Mircea C Dobre
- Department of Radiology, Stanford Hospitals and Clinics, Stanford, California, USA
| | | |
Collapse
|
33
|
Chung MP, Tang C, Chan C, Hara WY, Loo BW, Kaplan MJ, Fischbein N, Le QT, Chang DT. Radiotherapy for nonadenoid cystic carcinomas of major salivary glands. Am J Otolaryngol 2013; 34:425-30. [PMID: 23583094 DOI: 10.1016/j.amjoto.2013.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/10/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To report outcomes in patients treated with postoperative radiotherapy for nonadenoid cystic carcinomas of the major salivary glands. MATERIALS AND METHODS From 1998-2011, 37 patients with nonadenoid cystic carcinomas of the major salivary gland underwent postoperative radiotherapy. The median radiation dose was 60 Gy (range, 45-70 Gy). TNM distribution included T1-2 (n=16, 44%), T3-T4 (n=21, 56%), N0 (n=19, 51%), and N+ (n=18, 49%). Histologies included adenocarcinoma (n=13, 35%), squamous cell carcinoma (n=8, 22%), mucoepidermoid carcinoma (n=8, 22%), and other (n=8, 21%). Median follow-up was 4.7 years for all patients (range, 0.3-14.1 years) and 5.0 years for living patients (range, 1.2-12.2 years). RESULTS Five-year local-regional control, overall survival (OS), and cancer-specific survival (CSS) were 97%, 76%, and 84%. On univariate analysis, OS was significantly worse for patients ≥65 years old (p=0.04). CSS was significantly worse for positive perineural invasion (p=0.02), extraparenchymal extension (p=0.04), and in patients who received no chemotherapy (p=0.02). Doses >60 Gy was significantly worse for OS (p=0.003) and CSS (p=0.003), although these patients had higher TNM (>T2, p=0.01) and trended towards a higher rate of extraparenchymal extension (p=0.08). Four patients (11%) developed ≥grade 2 toxicities; 3 patients developed early toxicities and one patient developed late toxicities. CONCLUSIONS Radiotherapy for salivary gland tumors provides excellent local-regional control when combined with surgery. Distant metastasis is the predominant pattern of failure, although chemotherapy seemed to improve cancer-specific survival.
Collapse
Affiliation(s)
- Melody P Chung
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Alexander M, McTaggart R, Santarelli J, Fischbein N, Marks M, Zaharchuk G, Do H. Multimodality Evaluation of Dural Arteriovenous Fistula with CT Angiography, MR with Arterial Spin Labeling, and Digital Subtraction Angiography: Case Report. J Neuroimaging 2013; 24:520-3. [DOI: 10.1111/jon.12032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/24/2013] [Accepted: 02/03/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Ryan McTaggart
- Stanford University Medical Center; Department of Radiology; Stanford CA
| | - Justin Santarelli
- Stanford University Medical Center; Department of Radiology; Stanford CA
- Stanford University Medical Center; Department of Neurosurgery; Stanford CA
| | - Nancy Fischbein
- Stanford University Medical Center; Department of Radiology; Stanford CA
- Stanford University Medical Center; Department of Neurosurgery; Stanford CA
- Stanford University Medical Center; Department of Otolaryngology; Stanford CA
| | - Michael Marks
- Stanford University Medical Center; Department of Radiology; Stanford CA
- Stanford University Medical Center; Department of Neurosurgery; Stanford CA
| | - Greg Zaharchuk
- Stanford University Medical Center; Department of Radiology; Stanford CA
| | - Huy Do
- Stanford University Medical Center; Department of Radiology; Stanford CA
| |
Collapse
|
35
|
Aksoy D, Bammer R, Mlynash M, Venkatasubramanian C, Eyngorn I, Snider RW, Gupta SN, Narayana R, Fischbein N, Wijman CAC. Magnetic resonance imaging profile of blood-brain barrier injury in patients with acute intracerebral hemorrhage. J Am Heart Assoc 2013; 2:e000161. [PMID: 23709564 PMCID: PMC3698778 DOI: 10.1161/jaha.113.000161] [Citation(s) in RCA: 33] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Spontaneous intracerebral hemorrhage (ICH) is associated with blood–brain barrier (BBB) injury, which is a poorly understood factor in ICH pathogenesis, potentially contributing to edema formation and perihematomal tissue injury. We aimed to assess and quantify BBB permeability following human spontaneous ICH using dynamic contrast‐enhanced magnetic resonance imaging (DCE MRI). We also investigated whether hematoma size or location affected the amount of BBB leakage. Methods and Results Twenty‐five prospectively enrolled patients from the Diagnostic Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH) study were examined using DCE MRI at 1 week after symptom onset. Contrast agent dynamics in the brain tissue and general tracer kinetic modeling were used to estimate the forward leakage rate (Ktrans) in regions of interest (ROI) in and surrounding the hematoma and in contralateral mirror–image locations (control ROI). In all patients BBB permeability was significantly increased in the brain tissue immediately adjacent to the hematoma, that is, the hematoma rim, compared to the contralateral mirror ROI (P<0.0001). Large hematomas (>30 mL) had higher Ktrans values than small hematomas (P<0.005). Ktrans values of lobar hemorrhages were significantly higher than the Ktrans values of deep hemorrhages (P<0.005), independent of hematoma volume. Higher Ktrans values were associated with larger edema volumes. Conclusions BBB leakage in the brain tissue immediately bordering the hematoma can be measured and quantified by DCE MRI in human ICH. BBB leakage at 1 week is greater in larger hematomas as well as in hematomas in lobar locations and is associated with larger edema volumes.
Collapse
Affiliation(s)
- Didem Aksoy
- Stanford Neurocritical Care Program, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Wiegner EA, Daly ME, Murphy JD, Abelson J, Chapman CH, Chung M, Yu Y, Colevas AD, Kaplan MJ, Fischbein N, Le QT, Chang DT. Intensity-Modulated Radiotherapy for Tumors of the Nasal Cavity and Paranasal Sinuses: Clinical Outcomes and Patterns of Failure. Int J Radiat Oncol Biol Phys 2012; 83:243-51. [PMID: 22019239 DOI: 10.1016/j.ijrobp.2011.05.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 05/12/2011] [Accepted: 05/20/2011] [Indexed: 10/16/2022]
|
37
|
Woodard J, Fischbein N, Choudhry O, Bell-Stephens T, Steinberg G, Dorfman L. Moyamoya Disease Can Masquerade as Multiple Sclerosis (P02.146). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.146] [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: 11/15/2022] Open
|
38
|
Venkatasubramanian C, Fischbein N, Finley-Caulfield A, Snider RW, Eyngorn I, Buckwalter M, Hanley D, Kase C, Gean A, Zaharchuk G, Wintermark M, Wijman C. Abstract 3220: Does Multimodality MRI have Added Benefit in the Diagnosis and Management of “Classic” Hypertensive Intracerebral Hemorrhage? Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a3220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
It is unclear whether MRI adds benefit to non-contrast head CT (CT) in the diagnosis and management of patients with “classic” hypertensive intracerebral hemorrhage (HICH) on CT, and whether this additive information justifies MRI costs. We sought to answer this question using a prospective cohort of 159 consecutive patients with spontaneous ICH who systematically underwent CT and multimodality MRI.
Methods:
ICH etiology was classified in one of 12 predefined categories along with diagnostic certainty (highly probable, likely and possible), by two blinded neuroradiologists based on CT review (“CT diagnosis”). Two other blinded neuroradiologists reviewed in addition the MRI and determined the most likely diagnosis (“MRI diagnosis”). The “final” diagnosis was used as the reference standard and was assigned by two external, independent and blinded ICH clinician-experts who evaluated all clinical and imaging data including the initial and a 3 month MRI, CT angiography, contrast angiography, pathology and follow-up clinic visits, as available.
Results:
Of 159 patients, 86 (54%) had HICH as the final diagnosis. CT and MRI correctly identified 63 (73%) and 78 (91%) of these patients, respectively (P=0.005). Notably, MRI correctly classified eight of nine patients (89%) who had an “unknown” diagnosis by CT. Conversely, 74 patients were classified as HICH by the blinded CT review, and 64 (86%) of these patients had HICH as the final diagnosis. If the CT diagnosis was categorized as highly probable HICH (n=42), then it was almost always correct (98%). If the CT was categorized as likely (n=18) or possible (n=14) HICH, then it was correct in only 72% of cases. MRI increased diagnostic yield in the likely and possible categories by identifying one cavernous malformation (3%) and by improving diagnostic confidence in 19 patients (59%). MRI was wrong in three instances, all in the highly probable category (4%) by incorrectly classifying the etiology of intracerebral hemorrhage due to a possible vascular malformation (n=2) or coagulopathy (n=1).
Conclusions:
MRI is more accurate in correctly classifying hypertensive intracerebral hemorrhage than non contrast CT. MRI has significant additive yield over non contrast CT by improving diagnosis and diagnostic confidence in patients for whom the CT diagnosis is of intermediate or low certainty, but not for those diagnosed with a hypertensive intracerebral hemorrhage with high confidence.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Alisa Gean
- Univ of California, San Francisco, San francisco, CA
| | | | | | | |
Collapse
|
39
|
Aksoy D, Kleinman J, Snider RW, Eyngorn I, Mlynash M, Straka M, Bammer R, Gean AD, Fischbein N, Wijman CA. Abstract 2710: Aggressive Blood Pressure Lowering in Acute Intracerebral Hemorrhage is Associated with Perihematomal Hypoperfusion and Ischemia. Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a2710] [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
Introduction
Optimal blood pressure control following acute ICH remains controversial. Blood pressure reduction may limit hematoma expansion, but may also cause hypoperfusion and further damage in the perihematomal region. We examined the relationship between the extent and speed of systolic blood pressure (SBP) lowering and perihematomal perfusion and ischemia.
Methods
Consecutive prospectively enrolled ICH patients with an MRI within 24 hours of symptom onset were included. Hourly SBPs were recorded from hospital presentation to MRI acquisition. Aggressive BP lowering was defined as: ≥30% reduction from baseline
and
at least one BP drop of ≥35mmHg/h. Hematoma volume was considered large if ≥30cc. FLAIR, GRE and perfusion weighted images were co-registered. T
max
maps were generated using RApid processing of PerfusIon and Diffusion (RAPID) software. The perihematomal region was defined by outlining the perihematomal edema on FLAIR images and subtracting the inner surface of blood products on the GRE generating a perihematomal rim. Statistical analyses were done using MATLAB.
Results
Twenty-seven patients were included (age: 62.7±17.9years; ICH volume: 26±26cc). Six of 27 (22%) patients experienced aggressive SBP lowering. Numbers reported: mean(IQR). The aggressiveness of SBP reduction was similar in large versus small hematomas: the percentage drop in SBP was 26% (10-33) vs. 21% (13-28), and the highest SBP drop was 43mmHg/h (29-56) versus 46mmHg/h (31-51), p=0.61 and p=0.92, respectively. Patients with SBP drops ≥35mmHg/h tended to have delayed bolus arrival (high T
max
), 6.1s (4.8-7.7) versus 5.3s (3.5-5.6) (p=0.06), as did patients with SBP drops ≥30%,T
max
values 7.3s (6.2-8.6) versus 5.3s (3.6-6.2) (p=0.014). The effect was magnified in patients with a large (≥30%)
and
fast (≥35mmHg/h) drop in SBP, despite hematoma volumes being equivalent (p=0.01,
Figure1
). Five of 6 patients with aggressive SBP lowering had a T
max
>6s. Conversely, 7 out of 8 patients with modest SBP reduction had a T
max
≤6s (
Figure2
). Out of 11 patients with T
max
>6s, 8 had DWI lesions (73%) versus 4 of 16 (25%) with T
max
≤6s (p=0.02).
Conclusions:
Aggressive SBP lowering in acute ICH is associated with high T
max
values in the perihematomal region irrespective of hematoma volume. High T
max
values in turn are associated with DWI lesions.
Collapse
Affiliation(s)
- Didem Aksoy
- Stanford Neurocritical Care Program, Stanford Univ Med Cntr, Palo Alto, CA
| | | | - Ryan W Snider
- Stanford Neurocritical Care Program, Stanford Univ Med Cntr, Palo Alto, CA
| | - Irina Eyngorn
- Stanford Neurocritical Care Program, Stanford Univ Med Cntr, Palo Alto, CA
| | - Michael Mlynash
- Stanford Neurocritical Care Program, Stanford Univ Med Cntr, Palo Alto, CA
| | | | | | - Alisa D Gean
- Univ of California, San Francisco, Dept of Radiology, San Francisco, CA
| | | | - Christine A Wijman
- Stanford Neurocritical Care Program, Stanford Univ Med Cntr, Palo Alto, CA
| |
Collapse
|
40
|
Wijman CA, Snider RW, Venkatasubramanian C, Finley-Caulfield A, Buckwalter M, Eyngorn I, Fischbein N, Gean AD, Hanley DF, Kase CS, Kleinman JT, Schwartz NE, Lansberg MG, Albers GW, Mlynash M, Kemp S, Thai D, Narayana R, Marks M, Bammer R, Moseley M. Abstract 105: Diagnostic Accuracy of MRI in Spontaneous Intra-cerebral Hemorrhage (DASH) - Final Results. Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The optimal diagnostic evaluation for patients with a spontaneous intracerebral hemorrhage (ICH) or intraventricular hemorrhage (IVH) remains controversial. We aimed to assess the utility of early magnetic resonance imaging (MRI) in the diagnosis and management of these patients.
Methods:
Consecutive patients with spontaneous ICH or IVH were prospectively enrolled in this NIH funded study. Patients were excluded if they had a known (pre-existing) ICH source, a known inability to undergo MRI (e.g. pacemaker) or a Glasgow coma scale score ≤5. In addition to non-contrast brain CT and laboratory testing (including a toxicology screen and EKG), patients underwent gadolinium-enhanced MRI/MRA. Catheter angiography was pursued if the patient met pre-specified criteria. Survivors returned for a 90 day follow-up clinic visit with a repeat MRI. Based on clinical admission data and the initial head CT a presumed ICH cause was assigned by the treating neurocritical care/stroke neurologist. A choice was made out of 12 pre-specified etiologies. After subsequent review of the MRI, the neurologist was given the opportunity to modify the presumed ICH cause. The ‘gold standard’ ICH etiology was determined by a panel of two outside, independent and blinded ICH clinician experts after review of the complete medical record, first without the MRI results, reference standard 1 (RS1), and then with the MRI results, reference standard 2 (RS2). Changes in diagnostic category, diagnostic confidence and management were systematically recorded. The diagnostic yield of MRI was determined for each of the 12 diagnostic categories.
Results:
180 consecutive patients were prospectively enrolled. All patients underwent at least one MRI. No adverse events occurred during MRI acquisition. In 20 patients the MRI was obtained after surgical hematoma evacuation. Mean age was 62±17 years, 47% were female, and 71% had a history of hypertension. Median (IQR) GCS was 14 (10-15). Median and mean ICH volumes were 12 mL (4-35) and 24 (±28) mL. Hematoma location was lobar in 46% and deep in 39% of patients; 43% had associated IVH. Based on RS2, the final ICH diagnosis was hypertension in 44% and cerebral amyloid angiopathy in 13% of patients. MRI led to a change in diagnostic category in 14% of patients using RS1 as the reference, and 18% using RS2. MRI resulted in an improvement in diagnostic confidence in an additional 23% and 26% of patients, respectively. Management was changed in 13% of patients. Within diagnostic categories, the yield of MRI was highest for establishing diagnoses of ICH secondary to cerebral venous thrombosis (56%), ischemic stroke with hemorrhagic transformation (43%), cerebral amyloid angiopathy (35%), neoplasms (33%), and vascular malformations (31%).
Conclusions:
The results of this study demonstrate substantial additive clinical benefit of early routine MRI in patients with spontaneous ICH and/or IVH.
Collapse
Affiliation(s)
- Christine A Wijman
- Stanford Neurocritical Care Program, Stanford Sch of Medicine, Palo Alto, CA
| | - Ryan W Snider
- Stanford Neurocritical Care Program, Stanford Sch of Medicine, Palo Alto, CA
| | | | | | - Marion Buckwalter
- Stanford Neurocritical Care Program, Stanford Sch of Medicine, Palo Alto, CA
| | - Irina Eyngorn
- Stanford Neurocritical Care Program, Stanford Sch of Medicine, Palo Alto, CA
| | | | - Alisa D Gean
- Dept of Radiology, Univ of California, San Francisco, San Francisco, CA
| | - Daniel F Hanley
- Div of Brain Injury Outcomes, Johns Hopkins Univ, Baltimore, MD
| | | | - Jonathan T Kleinman
- Stanford Neurocritical Care Program, Stanford Sch of Medicine, Palo Alto, CA
| | - Neil E Schwartz
- Stanford Stroke Cntr, Stanford Sch of Medicine, Palo Alto, CA
| | | | | | - Michael Mlynash
- Stanford Stroke Cntr, Stanford Sch of Medicine, Palo Alto, CA
| | - Stephanie Kemp
- Stanford Stroke Cntr, Stanford Sch of Medicine, Palo Alto, CA
| | - Demi Thai
- Stanford Stroke Cntr, Stanford Sch of Medicine, Palo Alto, CA
| | - Rashmi Narayana
- Stanford Stroke Cntr, Stanford Sch of Medicine, Palo Alto, CA
| | - Michael Marks
- Dept of Radiology, Stanford Sch of Medicine, Palo Alto, CA
| | | | | |
Collapse
|
41
|
Lober R, Yeom K, Fischbein N, Edwards M, Harsh G, Vogel H, Mobley B. Role of Diffusion-Weighted MRI in Clival Chordoma. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312223] [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]
|
42
|
Kleinman JT, Ryan SR, Aksoy D, Mlynash M, Fischbein N, Gean AD, Eyngorn I, Venkatasubramanian C, Finley-Caulfield A, Wijman CA. Abstract 101: Is Intracerebral Hemorrhage-Associated Ischemia a Consequence of Blood Pressure Lowering? Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a101] [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
Introduction:
The cause of (presumed) ischemic lesions associated with intracerebral hemorrhage (ICH) is poorly understood. We investigated the relationship between BP lowering and the incidence of ipsilateral diffusion weighted imaging (DWI) lesions in a prospective ICH cohort.
Methods:
We prospectively enrolled consecutive ICH patients in the NIH-funded DiAgnostic Utility of MRI in Spontaneous Intracerebral Hemorrhage (DASH) study. Two neuroradiologists reviewed the MRIs for evidence of ischemia, defined as: reduced diffusivity ipsilateral to the ICH without evidence of blood products on FLAIR or GRE. Only DWI lesions attributed to tissue compression; vessel compression; or hypoperfusion were included. Patients with post-operative MRIs or insufficient BP data were excluded. Mean arterial blood pressures (MAP) were recorded on admission, and at 6, 12, 18, and 24 hours. Chi-square and t-tests were used as appropriate. Receiver operator characteristic (ROC) curves were created to assess accuracy of predicting DWI lesions.
Results:
Of 160 patients, 136 met inclusion criteria (median age: 63 (IQR 50-77); median ICH volume: 10 (IQR 4-33cc); median NIHSS: 6 (IQR 2-16); median GCS: 15 (IQR 10-15); median onset to MRI 40 hrs (IQR 25-75). DWI lesions were observed in 78 (57%) patients. Patients with DWI lesions had higher ICH volumes (32 vs 12cc, p < 0.001); higher admission MAP (125 vs 113mmHg, p=0.006); higher maximal MAP reduction (46 vs 33mmHg, p=0.008); and higher mean %MAP reduction (25 vs 17% p=0.006). DWI lesions were not associated with lowest MAP (80 vs 79mmHg, p=0.97) or mean MAP (90 vs 91, p=0.62). ICH volume and maximum MAP reduction predicted DWI lesions with an area under curve (AUC) of 0.70 (95% CI: 0.61-0.78) and 0.63 (95% CI: 0.53-0.72) respectively. Controlling for ICH volume using logistic regression: for every 10% reduction in MAP the risk of DWI lesions increased substantially (OR 1.28, 95% CI: 1.01-1.62). Similarly, each 10% reduction in mean MAP over the first 24 hours had an increased risk of detecting DWI lesions (OR 1.3, 95% CI: 1.01-1.69). The likelihood of having a DWI lesion was highest in patients with > 30mmHg drop in MAP (OR 2.3, 95% CI: 1.09-4.6). In ICH < 10cc (N=70), DWI lesions were not associated with ICH volume (4.1 vs 4.8cc, p=0.40) but with higher admission MAP (125 vs 112mmHg, p=0.045); maximum MAP reduction (45 vs 31 mmHg, p=0.03); and maximum % MAP reduction (34 vs 25%, p=0.03).
Conclusions:
ICH volume and large BP reductions are both associated with the presence of DWI lesions. The likelihood of having a DWI lesion went up by 30% for each 10% drop in MAP from admission, and was 230% higher in patients with > 30 mmHg reduction in MAP. These data suggest that aggressive BP reduction may contribute to ICH associated ischemia, and that percentage-based BP goals may be more appropriate than “one-size fits all” for clinical trial design. Future studies are needed to clarify causation.
Collapse
Affiliation(s)
| | | | | | | | | | - Alisa D Gean
- Univ of California San Francisco, San Francisco, CA
| | | | | | | | | | | |
Collapse
|
43
|
Karamchandani J, Vogel H, Fischbein N, Gibbs I, Edwards MS, Griffith H. Extravascular Papillary Endothelial Hyperplasia Mimicking Neoplasm After Radiosurgery. Neurosurgery 2011; 70:E1043-8; discussion E1048. [DOI: 10.1227/neu.0b013e31822e81f9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Papillary endothelial hyperplasia (PEH) is a rare form of exuberant reactive endothelial proliferation that can mimic neoplasm. We report the largest series of patients with histologically confirmed intracranial extravascular PEH developing in the field of previous treatment with stereotactic radiosurgery.
CLINICAL PRESENTATION:
We collected the clinical, radiological, surgical, and pathological findings from 4 patients in whom intracranial extravascular PEH developed after treatment with stereotactic radiosurgery. In all patients, the development of an enlarging hemorrhagic mass lesion at the site of previous radiotherapy on magnetic resonance imaging was radiographically suspicious for neoplasm and prompted biopsy or resection. All 4 patients elected to undergo biopsy or surgical resection. Histological examination of the biopsy and resection specimens in all patients demonstrated the classic features of PEH.
CONCLUSION:
The interval to the development of PEH ranged from 5 months to 6 years, 10 months. Clinical follow-up was available for 3 of the 4 patients. None of these 3 patients have demonstrated evidence of recurrence during a mean follow-up period of 22 months (range, 15–30 months). These patients share common radiological features, potentially allowing preoperative diagnosis and improved guidance of clinical management. These cases suggest a link between radiosurgery and the development of PEH. These findings also suggest that PEH should be considered in the differential diagnosis for patients treated with radiosurgery in whom a hemorrhagic mass lesion subsequently develops at or near the site of previous treatment. We think that complete surgical excision is the best treatment for intracranial PEH.
Collapse
Affiliation(s)
- Jason Karamchandani
- Department of Pathology, Stanford University Medical Center, Palo Alto, California
| | - Hannes Vogel
- Department of Pathology, Stanford University Medical Center, Palo Alto, California
| | - Nancy Fischbein
- Department of Radiology, Stanford University Medical Center, Palo Alto, California
| | - Iris Gibbs
- Department of Radiation Oncology, Stanford University Medical Center, Palo Alto, California
| | - Michael S.B. Edwards
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Harsh Griffith
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California
| |
Collapse
|
44
|
Abstract
OBJECTIVE Describe the first reported human intrathecal (IT) botulinum toxin injection. DESIGN Case report. SETTING AND PATIENTS We report here the sequelae to an unintended IT injection of botulinum toxin type B (BTB) in a 60-year-old woman with chronic back pain. RESULTS Following the IT administration of BTB, the patient experienced the onset of symmetric ascending stocking distribution painful dysesthesias, which persisted for approximately 6 months before receding. Objective neurologic deficits were not appreciated, and analgesic effects were prominently absent. CONCLUSIONS Analgesic actions of botulinum toxins in animals and in humans have led to speculation that IT botulinum toxin might exert significant analgesic effects. The unusual and unexpected subsequent clinical course, neurologic sequelae, dysesthesias, and absence of analgesia suggest that botulinum toxin will not be a therapeutic modality to treat pain as proposed by those studying botulinum toxin in animal models.
Collapse
Affiliation(s)
- Ian Carroll
- Division of Pain Management, Department of Anesthesiology, Stanford University, Palo Alto, CA 94040, USA.
| | | | | | | |
Collapse
|
45
|
Wiegner E, Daly M, Chapman C, Yu Y, Colevas A, Kaplan M, Fischbein N, Le Q, Chang D. Intensity Modulated Radiotherapy for Tumors of the Nasal Cavity and Paranasal Sinuses: Clinical Outcomes and Patterns of Failure. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Krakow T, Hara W, Yun S, Soltys S, Chang S, Fischbein N, Loo B, Le Q. Clinical Management of Patients with Temporal Lobe Necrosis. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1068] [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: 10/19/2022]
|
47
|
Parris D, Fischbein N, Mackey S, Carroll I. A novel CT-guided transpsoas approach to diagnostic genitofemoral nerve block and ablation. Pain Med 2010; 11:785-9. [PMID: 20546515 DOI: 10.1111/j.1526-4637.2010.00835.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines. CASE A 39-year-old woman with chronic lancinating right groin pain after inguinal hernia repair underwent multiple pharmacologic interventions and invasive procedures without relief. Using CT and Stimuplex nerve stimulator guidance, the genitofemoral nerve was localized on the anterior surface of the psoas muscle and a diagnostic block with local anesthetic block was performed. The patient had immediate relief of her symptoms for 36 hours, confirming the diagnosis of genitofemoral neuralgia. She subsequently underwent CT-guided radiofrequency and phenol ablation of the genitofemoral nerve but has not achieved long-term analgesia. CONCLUSION CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery.
Collapse
Affiliation(s)
- David Parris
- Department of Anesthesiology and Pain Management, Stanford University Medical Center, Stanford, California 94304, USA
| | | | | | | |
Collapse
|
48
|
Purcell DD, Fischbein N, Lalwani AK. Identification of previously “undetectable” abnormalities of the bony labyrinth with computed tomography measurement. Laryngoscope 2010; 113:1908-11. [PMID: 14603045 DOI: 10.1097/00005537-200311000-00009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with congenital sensorineural hearing loss (SNHL), a computed tomography (CT) scan of the temporal bone identifies inner ear malformations in approximately 25%, whereas the inner ear is grossly normal to visual inspection in the remaining 75% of the patients. In the latter group, the hearing loss is often attributed to radiologically undetectable abnormalities of the membranous labyrinth. However, subtle bony malformations may be missed because visual inspection alone is insensitive for detection. OBJECTIVE To test the hypothesis that there are subtle bony abnormalities of the inner ear in patients with SNHL who are radiologically deemed to have normal otic bone, using standardized measurements of the inner ear. STUDY DESIGN Retrospective review. METHODS Measurements of the cochlea, vestibule, and semicircular canals (SCCs) were made on axial and coronal temporal bone CT scans on 15 patients with normal hearing and 15 patients with congenital SNHL and grossly normal temporal bone CT scans. Student's t-test was performed to compare the measurements of the two groups. RESULTS All studies from the SNHL group were deemed normal by visual inspection and standardized measurements (+/-2 SD from normal). Surprisingly, there were significant differences in the measurements of the cochlea and of the SCCs between patients with and without SHNL (P <.05). CONCLUSIONS As a group, patients with SNHL and a "normal CT scan" have significant differences in the dimensions of the inner ear. This suggests that these patients have disturbed morphogenesis of both membranous and bony labyrinth. This novel observation has important implications for understanding the etiology of SNHL.
Collapse
Affiliation(s)
- Derk D Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, USA
| | | | | |
Collapse
|
49
|
Wijman CAC, Venkatasubramanian C, Bruins S, Fischbein N, Schwartz N. Utility of early MRI in the diagnosis and management of acute spontaneous intracerebral hemorrhage. Cerebrovasc Dis 2010; 30:456-63. [PMID: 20733299 DOI: 10.1159/000316892] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 05/31/2010] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The optimal diagnostic evaluation for spontaneous intracerebral hemorrhage (ICH) remains controversial. In this retrospective study, we assessed the utility of early magnetic resonance imaging (MRI) in ICH diagnosis and management. METHODS Eighty-nine (72%) of 123 patients with spontaneous ICH underwent a brain CT and MRI within 30 days of ICH onset. Seventy patients with a mean age of 62 ± 15 years were included. A stroke neurologist and a general neurologist, each blinded to the final diagnosis, independently reviewed the admission data and the initial head CT and then assigned a presumed ICH cause under 1 of 9 categories. ICH cause was potentially modified after subsequent MRI review. The final 'gold standard' ICH etiology was determined after review of the complete medical record by an independent investigator. Change in diagnostic category and confidence and the potential impact on patient management were systematically recorded. RESULTS Mean time to MRI was 3 ± 5 days. Final ICH diagnosis was hypertension or cerebral amyloid angiopathy (CAA) in 50% of patients. After MRI review the stroke neurologist changed diagnostic category in 14%, diagnostic confidence in an additional 23% and management in 20%, and the general neurologist did so in 19, 21 and 21% of patients, respectively. MRI yield was highest in ICH secondary to ischemic stroke, CAA, vascular malformations and neoplasms, and did not differ by age, history of hypertension, hematoma location or the presence of intraventricular hemorrhage. CONCLUSIONS The results of this study suggest potential additive clinical benefit of early MRI in patients with spontaneous ICH.
Collapse
Affiliation(s)
- Christine A C Wijman
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, 701 Welch Road, Palo Alto, CA 94034, USA.
| | | | | | | | | |
Collapse
|
50
|
|