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Kamble AN, Agrawal NK, Koundal S, Bhargava S, Kamble AN, Joyner DA, Kalelioglu T, Patel SH, Jain R. Imaging-based stratification of adult gliomas prognosticates survival and correlates with the 2021 WHO classification. Neuroradiology 2023; 65:41-54. [PMID: 35876874 DOI: 10.1007/s00234-022-03015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/08/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Because of the lack of global accessibility, delay, and cost-effectiveness of genetic testing, there is a clinical need for an imaging-based stratification of gliomas that can prognosticate survival and correlate with the 2021-WHO classification. METHODS In this retrospective study, adult primary glioma patients with pre-surgery/pre-treatment MRI brain images having T2, FLAIR, T1, T1 post-contrast, DWI sequences, and survival information were included in TCIA training-dataset (n = 275) and independent validation-dataset (n = 200). A flowchart for imaging-based stratification of adult gliomas(IBGS) was created in consensus by three authors to encompass all adult glioma types. Diagnostic features used were T2-FLAIR mismatch sign, central necrosis with peripheral enhancement, diffusion restriction, and continuous cortex sign. Roman numerals (I, II, and III) denote IBGS types. Two independent teams of three and two radiologists, blinded to genetic, histology, and survival information, manually read MRI into three types based on the flowchart. Overall survival-analysis was done using age-adjusted Cox-regression analysis, which provided both hazard-ratio (HR) and area-under-curve (AUC) for each stratification system(IBGS and 2021-WHO). The sensitivity and specificity of each IBSG type were analyzed with cross-table to identify the corresponding 2021-WHO genotype. RESULTS Imaging-based stratification was statistically significant in predicting survival in both datasets with good inter-observer agreement (age-adjusted Cox-regression, AUC > 0.5, k > 0.6, p < 0.001). IBGS type-I, type-II, and type-III gliomas had good specificity in identifying IDHmut 1p19q-codel oligodendroglioma (training - 97%, validation - 85%); IDHmut 1p19q non-codel astrocytoma (training - 80%, validation - 85.9%); and IDHwt glioblastoma (training - 76.5%, validation- 87.3%) respectively (p-value < 0.01). CONCLUSIONS Imaging-based stratification of adult diffuse gliomas predicted patient survival and correlated well with 2021-WHO glioma classification.
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Affiliation(s)
- Akshaykumar N Kamble
- University Hospitals Coventry & Warwickshire, Coventry, UK.
- Deep Learning Institute of Radiological Sciences (DeLoRIS), Mumbai, India.
| | - Nidhi K Agrawal
- Deep Learning Institute of Radiological Sciences (DeLoRIS), Mumbai, India
- Max Super-Specialty Hospital, Mohali, India
| | - Surabhi Koundal
- Department of Radiology, Institute of Nuclear Medicine & Allied Sciences (INMAS), New Delhi, India
| | | | | | - David A Joyner
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Tuba Kalelioglu
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Sohil H Patel
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Rajan Jain
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, NY, USA
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Bunevicius A, Joyner DA, Muttikkal TE, Ahn J, Sheehan J. Magnetic Resonance Perfusion Changes of Arteriovenous Malformations Treated with Stereotactic Radiosurgery. World Neurosurg 2020; 146:e1003-e1011. [PMID: 33227527 DOI: 10.1016/j.wneu.2020.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The latency period from stereotactic radiosurgery (SRS) to obliteration of arteriovenous malformations (AVM) requires continuous imaging surveillance. Magnetic resonance (MR) perfusion is promising for noninvasive monitoring of AVMs after SRS. We studied longitudinal MR perfusion changes of brain AVMs treated with SRS. METHODS Consecutive patients treated for brain AVMs using SRS who had MR perfusion imaging studies performed before and at least once after SRS were studied. We estimated ipsilateral/contralateral brain hemisphere ratios of MR perfusion indexes, including regional cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV), in the AVM nidus, perinidal region, and remote anterior and posterior brain regions. RESULTS Eleven patients (6 women; median age, 21 years) underwent SRS (median prescription dose, 18 Gy; range, 12-20 Gy) for brain AVMs (median Spetzler-Martin grade 2 and median volume 4.6 mL). Before the SRS, rCBV and rCBF ratios were significantly higher in the AVM nidus compared with other investigated brain regions (P < 0.001). Median time from SRS to the first and last post-SRS MR perfusion studies was 8 and 35 months, respectively. There was a statically significant decrease of rCBV (P = 0.043) and rCBF (P = 0.036) ratios in the AVM nidus, but not other brain regions, during post-SRS follow-up. CONCLUSIONS There is a gradual decrease of rCBV and rCBF in the AVM nidus after SRS. MR perfusion imaging is promising for monitoring of hemodynamic changes of AVMs after SRS. Larger studies investigating clinical value of MR perfusion imaging for AVMs after SRS are warranted.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David A Joyner
- Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Jungeun Ahn
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
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Hooker JD, Khan MA, Farkas AB, Lirette ST, Joyner DA, Gordy DP, Storrs JM, Roda MS, Bofill JA, Smith AD, James JR. Third-trimester in utero fetal brain diffusion tensor imaging fiber tractography: a prospective longitudinal characterization of normal white matter tract development. Pediatr Radiol 2020; 50:973-983. [PMID: 32399686 DOI: 10.1007/s00247-020-04639-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/30/2019] [Accepted: 02/11/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND White matter is responsible for inter-neuronal connections throughout the brain that are a driving force in cognitive development. Diffusion tensor imaging (DTI) fiber tractography has been used to evaluate white matter development in the fetal brain; however, longitudinal studies of DTI fiber tractography to assess white matter development in the third trimester are lacking. OBJECTIVE To characterize in utero longitudinal changes in the fetal brain DTI fiber tracts of normal third-trimester fetuses. MATERIALS AND METHODS For this single-center prospective longitudinal observational pilot study, we recruited 28 pregnant females with normal third-trimester pregnancies who had routine prenatal ultrasound. MRI of the in utero fetal brain was performed with a Siemens 1.5-tesla (T) Espree scanner at 31 weeks, 33 weeks and 36 weeks of gestation, with 14 DTI tractography parameters quantified in 7 brain regions using DTI-studio version 2.4 (Johns Hopkins University, Baltimore, MD; n=98 measurements). We used multilevel mixed models to examine the relationship between longitudinal changes in DTI measurements and between 98 DTI measurements at 31 weeks and 4 routine fetal brain anatomical biometrics (n=392 assessments). RESULTS We observed statistically significant decreases in radial diffusivity and apparent diffusion coefficient in 13 of 14 brain regions from 31 weeks to 36 weeks of gestation (P<0.001 for all regions except the genu of the corpus callosum). Significant decreases in radial diffusivity from weeks 33 to 36 and weeks 31 to 36 were seen in the corticospinal tracts, centrum semiovale, posterior limb of the internal capsule, and crus cerebri (P<0.001 for all). When considering all possible combinations of DTI fiber tract measurements and the routine morphological fetal brain biometrics, only 6% (24/392) had a significant association (P<0.05), indicating relative independence of the DTI fiber tract measurements from anatomical biometrics. CONCLUSION In utero longitudinal changes in fetal brain DTI fiber tractography are quantifiable in normal third-trimester fetuses and are largely independent of morphological brain changes.
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Affiliation(s)
- Jeffrey D Hooker
- Department of Radiology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA.
| | - Majid A Khan
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amy B Farkas
- Department of Radiology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - Seth T Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - David P Gordy
- Department of Radiology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - Judd M Storrs
- Department of Radiology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - Manohar S Roda
- Department of Radiology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - James A Bofill
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrew D Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Judy R James
- Department of Radiology and Imaging Sciences, Indiana University Health University Hospital, Indianapolis, IN, USA
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Moazzami K, Shao IY, Chen LY, Lutsey PL, Jack CR, Mosley T, Joyner DA, Gottesman R, Alonso A. Atrial Fibrillation, Brain Volumes, and Subclinical Cerebrovascular Disease (from the Atherosclerosis Risk in Communities Neurocognitive Study [ARIC-NCS]). Am J Cardiol 2020; 125:222-228. [PMID: 31771759 PMCID: PMC6942172 DOI: 10.1016/j.amjcard.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 01/24/2023]
Abstract
The aim of the present study was to investigate the association between atrial fibrillation (AF) and total and regional brain volumes among participants in the community-based Atherosclerosis Risk in Communities Neurocognitive study (ARIC-NCS). A total of 1,930 participants (130 with AF) with a mean age of 76.3 ± 5.2, who underwent 3T brain MRI scans in 2011 to 2013 were included. Prevalent AF was ascertained from study ECGs and hospital discharge codes. Brain volumes were measured using FreeSurfer image analysis software. Markers of subclinical cerebrovascular disease included lobar microhemorrhages, subcortical microhemorrhages, cortical infarcts, subcortical infarcts, lacunar infarcts, and volume of white matter hyperintensities. Linear regression models were used to assess the associations between AF status and brain volumes. In adjusted analyses, AF was not associated with markers of subclinical cerebrovascular disease. However, AF was associated with smaller regional brain volumes (including temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all p <0.05]) after controlling for demographics, cardiovascular risk factors, prevalent cardiovascular disease, and markers of subclinical cerebrovascular disease. Subgroup analysis revealed a significant interaction between AF and total brain volume with respect to age (p = 0.02), with associations between AF and smaller brain volumes being stronger for older individuals. In conclusion, AF was associated with smaller brain volumes, and the association was stronger among older individuals. This finding may be related to the longer exposure period of the older population to AF or the possibility that older people are more susceptible to the effects of AF on brain volume.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Iris Yuefan Shao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Abstract
In fall 2014, we launched a foundational course in artificial intelligence (CS7637: Knowledge-Based AI) as part of the Georgia Institute of Technology's Online Master of Science in Computer Science program. We incorporated principles and practices from the cognitive and learning sciences into the development of the online AI course. We also integrated AI techniques into the instruction of the course, including embedding 100 highly focused intelligent tutoring agents in the video lessons. By now, more than 2000 students have taken the course. Evaluations have indicated that OMSCS students enjoy the course compared to traditional courses, and more importantly, that online students have matched residential students' performance on the same assessments. In this article, we present the design, delivery, and evaluation of the course, focusing on the use of AI for teaching AI. We also discuss lessons we learned for scaling the teaching and learning of AI.
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Kazimirko DN, Parker EE, Joyner DA, Berry TH, Taylor CS, Nichols TA, Khan MA. An unusual cause of acute headache: subarachnoid free air secondary to spontaneous bronchopleurodurosubarachnoid fistula from a Pancoast tumor. Radiol Case Rep 2016; 11:238-41. [PMID: 27594957 PMCID: PMC4996922 DOI: 10.1016/j.radcr.2016.06.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/07/2016] [Indexed: 11/08/2022] Open
Abstract
Pneumocephalus and pneumorrhachis are related to transgression of the barriers to the central nervous system. We present a patient with a Pancoast tumor treated with palliative chemoradiation who developed symptomatic spinal and intracranial air caused by spontaneous bronchopleurodurosubarachnoid fistula secondary to direct tumor invasion into the thecal sac.
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Affiliation(s)
- Dmitriy N Kazimirko
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Ellen E Parker
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Teddi H Berry
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Charlotte S Taylor
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Todd A Nichols
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Majid A Khan
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
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Abstract
Eagle syndrome is a rare condition resulting from elongation of the temporal styloid process or calcification of its associated stylohyoid ligaments. Although usually presenting with pain or odynophagia, Eagle syndrome has been reported to cause a multitude of neurologic symptoms or vascular complications, some of which can be life-threatening. We present a case in which an endovascularly placed internal carotid artery stent in close proximity to a calcified stylohyoid ligament resulted in stent fracture with subsequent stent and vessel occlusion. We review and discuss the presentation, diagnosis, etiology, complications and treatment options of the syndrome.
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Affiliation(s)
- Jeffrey D Hooker
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Edward P Farley
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Majid Khan
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
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Horton WB, Joyner DA, Daley WP, Pitman KT, Khan MA. Nasopharyngeal dendritic cell sarcoma, not otherwise specified, in a 34-year-old man. Ear Nose Throat J 2011; 90:E7-10. [PMID: 21674462 DOI: 10.1177/014556131109000617] [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: 11/15/2022] Open
Abstract
Dendritic cell sarcoma, not otherwise specified (NOS), is an entity that is poorly defined because of its rarity and poorly understood pathogenesis. It is characterized by positive immunohistochemical staining for S-100 and CD1a, along with an absence of cytoplasmic Birbeck granules on electron microscopy. We report the case of a surgically inaccessible nasopharyngeal dendritic cell sarcoma, NOS, in a 34-year-old man. Treatment with chemotherapy along with adjuvant radiation therapy was successful in decreasing the size of the nasopharyngeal mass, and the patient remained free of any evidence of recurrence nearly 5 years after treatment.
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Affiliation(s)
- William B Horton
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA.
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