Three patients had severe ataxia and memory impairment in a phase 1 trial of a fatty acid amide hydrolase inhibitor designed as an analgesic and antiinflammatory drug. One patient became brain dead. ...MRI of the brain showed lesions in the pons and hippocampi.
A decrease in fatty acid amide hydrolase (FAAH) activity increases the levels of endogenous analogues of cannabinoids, or endocannabinoids.
1
FAAH inhibitors have shown analgesic and antiinflammatory activity in animal models,
2
and some have been tested for these purposes in phase 1 and phase 2 studies.
3
Phase 3 studies were not pursued owing to a lack of efficacy. BIA 10-2474, with the chemical name 3-(1-(cyclohexyl(methyl)carbamoyl)-1H-imidazol-4-yl)pyridine 1-oxide, is a new reversible FAAH inhibitor. A phase 1 study was conducted in healthy volunteers to explore the safety profile of BIA 10-2474. Five of the six participants who had received the highest cumulative dose . . .
The WEB is an innovative flow disruption device for cerebral aneurysm embolization with rapidly expanding indications. Our purpose was to evaluate the diagnostic performance of computed tomography ...angiography (CTA) at 1-year follow-up of aneurysms treated with the WEB.
Between April 2014 and May 2016, the study prospectively included patients treated with the WEB at our institution, and followed up within 24hours by CTA and at 1year by CTA, time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA). The diagnostic quality of imaging data was assessed based on the confidence index, artifacts, and WEB shape depiction. The imaging diagnostic performance was assessed using 3 criteria at 1year: aneurysm occlusion status and worsening, and WEB shape compression. Interobserver and intermodality agreement was determined by calculating κ values.
The study ultimately included 16 patients (9 women, mean age 53±7.6years). CTA quality confidence was scored as 2/2, artifacts 0.4/2 and WEB shape depiction 1.9/2, superior to TOF MRA for the latter two criteria. Aneurysm occlusion was adequate in 93.7% of patients, with CTA showing excellent interobserver reproducibility and agreement with DSA on a 4-grade scale (κ=1.00), while TOF MRA yielded good reproducibility (κ=0.76) and agreement with DSA (κ=0.69). CTA also identified aneurysm occlusion worsening (43.7%) and WEB compression (81.2%) in excellent agreement with DSA (κ=0.85 and 1.00).
CTA is a reproducible and reliable technique for the follow-up of aneurysms treated with the WEB device.
BACKGROUND:Susceptibility-weighted imaging (SWI) of brain tumors provides information about neoplastic vasculature and intratumoral micro- and macrobleedings. Low- and high-grade gliomas can be ...distinguished by SWI due to their different vascular characteristics. Fractal analysis allows for quantification of these radiological differences by a computer-based morphological assessment of SWI patterns.
OBJECTIVE:To show the feasibility of SWI analysis on 3-T magnetic resonance imaging to distinguish different kinds of brain tumors.
METHODS:Seventy-eight patients affected by brain tumors of different histopathology (low- and high-grade gliomas, metastases, meningiomas, lymphomas) were included. All patients underwent preoperative 3-T magnetic resonance imaging including SWI, on which the lesions were contoured. The images underwent automated computation, extracting 2 quantitative parametersthe volume fraction of SWI signals within the tumors (signal ratio) and the morphological self-similar features (fractal dimension FD). The results were then correlated with each histopathological type of tumor.
RESULTS:Signal ratio and FD were able to differentiate low-grade gliomas from grade III and IV gliomas, metastases, and meningiomas (P < .05). FD was statistically different between lymphomas and high-grade gliomas (P < .05). A receiver-operating characteristic analysis showed that the optimal cutoff value for differentiating low- from high-grade gliomas was 1.75 for FD (sensitivity, 81%; specificity, 89%) and 0.03 for signal ratio (sensitivity, 80%; specificity, 86%).
CONCLUSION:FD of SWI on 3-T magnetic resonance imaging is a novel image biomarker for glioma grading and brain tumor characterization. Computational models offer promising results that may improve diagnosis and open perspectives in the radiological assessment of brain tumors.
ABBREVIATIONS:FD, fractal dimensionSR, signal ratioSWI, susceptibility-weighted imaging
Differentiating brain metastasis recurrence from radiation necrosis can be challenging during MRI follow-up after stereotactic radiotherapy. 18F-FDG is the most available PET tracer, but standard ...images performed 30 to 60 minutes postinjection provide insufficient accuracy. We compared the diagnostic performance and interobserver agreement of 18F-FDG PET with delayed images (4-5 hours postinjection) with the ones provided by standard and dual-time-point imaging.
Consecutive patients referred for brain 18F-FDG PET after inconclusive MRI were retrospectively included between 2015 and 2020 in 3 centers. Two independent nuclear medicine physicians interpreted standard (visually), delayed (visually), and dual-time-point (semiquantitatively) images, respectively. Adjudication was applied in case of discrepancy. The final diagnosis was confirmed histologically or after 6 months of MRI follow-up. Areas under the receiver operating characteristic curves were pairwise compared.
Forty-eight lesions from 46 patients were analyzed. Primary tumors were mostly located in the lungs (57%) and breast (23%). The median delay between radiotherapy and PET was 15.7 months. The final diagnosis was tumor recurrence in 24 of 48 lesions (50%), with histological confirmation in 19 of 48 lesions (40%). Delayed images provided a larger area under the receiver operating characteristic curve (0.88; 95% confidence interval CI, 0.75-0.95) than both standard (0.69; 95% CI, 0.54-0.81; P = 0.0014) and dual-time-point imaging (0.77; 95% CI, 0.63-0.88; P = 0.045), respectively. Interobserver agreement was almost perfect with delayed images (κ = 0.83), whereas it was moderate with both standard (κ = 0.48) and dual-time-point images (κ = 0.61).
18F-FDG PET with delayed images is an accurate and reliable alternative to differentiate metastasis recurrence from radiation necrosis in case of inconclusive MRI after brain stereotactic radiotherapy.
Purpose
We aimed to compare spatial extent of high-grade subregions detected with combined
18
F-dihydroxyphenylalanine (
18
F-DOPA) PET and MRI to the one provided by advanced multimodal MRI alone ...including Contrast-enhanced (CE) and Perfusion weighted imaging (PWI). Then, we compared the accuracy between imaging modalities, in a per biopsy analysis.
Methods
Participants with suspected diffuse glioma were prospectively included between June 2018 and September 2019. Volumes of high-grade subregions were delineated respectively on
18
F-DOPA PET and MRI (CE and PWI). Up to three per-surgical neuronavigation-guided biopsies were performed per patient.
Results
Thirty-eight biopsy samples from sixteen participants were analyzed. Six participants (38%) had grade IV IDH wild-type glioblastoma, six (38%) had grade III IDH-mutated astrocytoma and four (24%) had grade II IDH-mutated gliomas. Three patients had intratumoral heterogeneity with coexisting high- and low-grade tumor subregions. High-grade volumes determined with combined
18
F-DOPA PET/MRI (median of 1.7 interquartile range (IQR) 0.0, 19.1 mL) were larger than with multimodal MRI alone (median 1.3 IQR 0.0, 12.8 mL) with low overlap (median Dice’s coefficient 0.24 IQR 0.08, 0.59). Delineation volumes were substantially increased in five (31%) patients. In a per biopsy analysis, combined
18
F-DOPA PET/MRI detected high-grade subregions with an accuracy of 58% compared to 42% (p = 0.03) with CE MRI alone and 50% (p = 0.25) using multimodal MRI (CE + PWI).
Conclusions
The addition of
18
F-DOPA PET to multimodal MRI (CE and PWI) enlarged the delineation volumes and enhanced overall accuracy for detection of high-grade subregions. Thus, combining
18
F-DOPA with advanced MRI may improve treatment planning in newly diagnosed gliomas.
Abstract Arterial spin labeling (ASL) perfusion is a MRI technique to quantify tissue blood flow. ASL is a non-invasive technique that labels the protons in the arterial blood by radiofrequency ...pulses, without the exogenous injection of contrast media. This article has three goals: 1) present the principles of ASL perfusion, the types of labeling and the ways to obtain the mapping; 2) specify and the quality criteria for the mapping obtained, while emphasizing the artifacts; and 3) describe the main encephalic and renal applications.
Purpose
Ferromagnetic foreign bodies (FFB) present during magnetic resonance imaging (MRI) explorations can lead to tissue injury due to movement, especially in and around the eyes. Ferromagnetic ...foreign bodies located in the intraocular area, eyelids, and orbit are thus prohibited from undergoing MRI. The aim of the study was to analyze movement of 4-mm ferromagnetic foreign bodies in MRI in the eye, eyelid, and orbit using computed tomography (CT) scan.
Method
We developed a porcine model using 12 quarters of fresh porcine heads. Each porcine head included one whole orbit with the ocular globe, orbital fat, muscles, and eyelids. Four-millimeter FFB were implanted in the eye within 2 days post-slaughter, and images were acquired within 5 days post-slaughter. Four-millimeter FFB movement was analyzed after 1.5-Tesla (T) MRI. Four locations were tested: intravitreous, suprachoroidal, intraorbital fat, and intrapalpebral. Movement analysis was assessed using computed tomography (CT) scan.
Results
The intravitreous ferromagnetic ball moved 14.0 ± 8.8 mm (
p
< 0.01), the suprachoroidal ball moved 16.8 ± 5.4 mm (
p
< 0.01), the intraorbital fat ball moved 5.8 ± 0.9 mm (
p
> 0.05), and the intrapalpebral ball moved 2.0 ± 0.4 mm (
p
> 0.05).
Conclusion
The ex vivo porcine model was able to study FFB movement. The 4-mm ferromagnetic balls moved in intravitreous and in suprachoroidal locations after MRI.
To compare 3D time-of-flight MR angiography (TOF-MRA) at 3 Tesla (3T) with digital subtraction angiography (DSA) for the evaluation of intracranial aneurysm occlusion after endovascular coiling.
In a ...prospective study, 51 consecutive patients (25 females, 26 males; median age, 51 years) with 51 saccular aneurysms treated with endovascular coiling underwent simultaneous DSA and 3T TOF-MRA at follow-up. DSA and TOF-MRA images were analyzed independently by two senior neuroradiologists. Findings were assigned to 1 of 3 categories in the Raymond classification: complete obliteration, residual neck or residual aneurysm. Agreement between observers and techniques was evaluated using kappa statistics.
DSA images were not interpretable for one patient. Interobserver agreement was determined as excellent for DSA (kappa=0.86) and TOF-MRA (kappa=0.80). After reaching a consensus, DSA follow-up showed 26 (51%) complete obliterations, 20 (39%) residual necks and 4 (8%) residual aneurysms. TOF-MRA showed 23 (45%) complete obliterations, 22 (43%) residual necks and 6 (12%) residual aneurysms. Comparison between TOF-MRA and DSA showed excellent agreement between the techniques (kappa=0.86). In the four cases that were misclassified, TOF-MRA findings were assigned to a higher class than for DSA.
TOF-MRA at 3T is at least as efficient as DSA for the evaluation of intracranial aneurysm occlusion after endovascular treatment with detachable coils. We suggest that TOF-MRA at 3T might be used as the primary method for imaging follow-up of coiled intracranial aneurysms.
La maladie d’Erdheim Chester est une forme rare d’histiocytose non Langerhansienne dont les manifestations peuvent être plurisystémiques. Nous rapportons un cas dont l’atteinte neurologique est à ...l’origine du diagnostic.
Il s’agit d’une patiente de 71 ans, dont les antécédents sont dominés par un adénocarcinome colique en rémission. L’entourage et la patiente rapportent un ralentissement idéomoteur et des troubles de l’équilibre aggravatifs depuis 2 ans, responsable d’une perte d’autonomie. La patiente est asthénique, présente plusieurs xanthomes cutanés. L’examen neurologique montre une dysarthrie d’allure cérébelleuse, une stase salivaire avec quelques troubles de déglutition, une hypotonie vélaire ; il existe aussi une ataxie cérébelleuse avec un syndrome cinétique et statique, un signe de Babinski bilatéral, un déficit musculaire assez homogène modéré (4 à 4+/5). Au plan biologique, il existe une insuffisance rénale modérée chronique (Créatininémie à 145μmol/l), un syndrome inflammatoire (45<CRP<80mg/L). La biopsie cutanée montre des histiocytes spumeux CD68+ ; mutation BRAFV600Epositive. La scintigraphie osseuse documente une atteinte de la partie métaphyso-diaphysaire des os longs avec épargne des épiphyses. L’IRM cérébrale documente des anomalies sinusiennes, une anomalie péri-vasculaire de l’artère vertébrale droite, un hypersignal des noyaux dentelés. Les autres examens sont en faveur d’une atteinte rétropéritonéale, cardiaque et hypophysaire.
L’atteinte neurologique clinique a été insidieuse, et le diagnostic finalement assez tardif après l’apparition des premiers xanthomes (2008). Les atteintes cérébrales rapportées dans la littérature sont des masses d’allure tumorale intra ou extra axiales, dont la localisation et le degré de compression expliquent les manifestations cliniques. Plus rarement, il s’agit d’engainement péri-vasculaire, aspect plus classiquement retrouvé au niveau aortique.
Notre patiente présente une maladie d’Erdheim Chester plurisystémique, typique bien qu’exceptionnelle. Dans notre cas, l’expertise radiologique a été primordiale pour orienter le diagnostic et débuter le traitement rapidement.
![Delayed [18F]-FDG PET Imagi...](http://api.summon.serialssolutions.com/2.0.0/image/issn/XR4PS5YY4K/0363-9762_1536-0229/small "Delayed [18F]-FDG PET Imaging Increases Diagnostic Performance and Reproducibility to Differentiate Recurrence of Brain Metastases From Radionecrosis")
PDF
