Standard treatment for patients with primary glioblastoma (GBM) includes surgery, radiotherapy, and concomitant and adjuvant temozolomide (TMZ). Recent reports have demonstrated that TMZ-induced ...myelosuppression correlates with survival in patients with GBM. However, those results were evaluated before the 2016 revision of the World Health Organization classification. This study examined whether myelosuppression during concomitant TMZ phase correlates with prognosis in GBM, IDH-wildtype patients. We examined circulating blood cell counts in 50 patients with GBM, IDH-wildtype who received the standard treatment protocol between August 2005 and November 2015. We assessed relationships between rates of decrease in blood cells (white blood cells (WBC), neutrophils, lymphocytes, red blood cells, and platelets) during the concomitant TMZ phase and overall survival (OS) using univariate and multivariate analyses including other clinicopathological factors (age, sex, Karnofsky Performance Status (KPS), extent of resection, O
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-methylguanine-DNA methyltransferase (MGMT) status). Log-rank testing revealed that age, KPS, extent of resection, MGMT status, and decrease rates of WBC, neutrophils, and platelets correlated significantly with OS. On multivariate analysis, age, MGMT status, and decrease rate of neutrophils correlated significantly with OS. Patients with a ≥ 40% decrease in neutrophils showed significantly longer OS than those with < 40% (hazard ratio = 2.815; 95% confidence interval = 1.177–7.038;
P
= 0.0196). A decrease of ≥ 40% in neutrophils represents a predictor of good prognosis for GBM, IDH-wildtype. Blood cell counts during the concomitant TMZ phase can help predict OS in patients with GBM, IDH-wildtype receiving the standard treatment protocol.
•Statistical inverse correlation at regular b-value based ADC and the cellularity.•High b-value based ADC reflects the cellularity more accurately.•The cellularity of pediatric posterior fossa tumors ...depends on pathological types.•High b-value based ADC helps differentiation of pediatric posterior fossa tumors.
The pediatric posterior fossa (PF) brain tumors with higher frequencies are embryonal tumors (ET), ependymal tumors (EPN) and pilocytic astrocytomas (PA), however, it is often difficult to make a differential diagnosis among them with conventional MRI. The ADC calculated from DWI could be beneficial for diagnostic work up.
We acquired DWI at b = 1000 and 4000(s/mm2). The relationship between ADC and the three types of brain tumors was evaluated with Mann-Whitney U test. We also performed simple linear regression analysis to evaluate the relationship between ADC and cellularity, and implemented receiver operating characteristic curve (ROC curve) to test the diagnostic performance among tumors.
The highest ADC (b1000/b4000 × 10−3 mm2/s) was observed in PA (1.02−1.91/0.73−1.28), followed by PF-EPN (0.83−1.28/0.60−0.79) and the lowest was ET (0.41−0.75/0.29−0.47). There was significant difference among the groups in both ADC value (b-1000/b-4000: ET vs. PF-EPN p < 0.0001/0.0001, ET vs. PA p < 0.0001/0.0001, PF-EPN vs. PA p < 0.0001/0.0001). ROC analysis revealed that ADC in both b-values showed complete separation between ET and PF-EPN. And it also revealed that ADC at b-4000 could differentiate PF-EPN and PA (96.0%) better than ADC at b-1000 (90.1%). The stronger negative correlation was observed between the ADC and cellularity at b-4000 than at b-1000 (R2 = 0.7415 vs.0.7070)
ADC of ET was significantly lower than the other two groups, and ADC of PA was significantly higher than the other two groups in both b-1000 and b-4000. Our results showed that ADC at b-4000 was more useful than ADC at b-1000 especially for differentiation between PF-EPN and PA.
The ischemic risk in prophylactic treatments of unruptured intracranial aneurysms (UIAs) is a serious health concern.
The aim of this study was to elucidate the incidence and characteristics of ...ischemic events in microsurgical clipping of anterior circulation UIAs.
Ischemic events were prospectively evaluated before and after surgery between April 2011 and March 2017. The location, volume, minimum value of apparent diffusion coefficient in high-intensity spots (HIS) on 3-T magnetic resonance diffusion-weighted imaging (DWI), and radiographic outcomes were analyzed. The relationships between DWI positivity and patient demographics, surgical procedures, and intraoperative vessel features were assessed.
Overall, 78 consecutive patients including 29 men and 49 women (median age, 62 years; range, 24–77 years) with 99 UIAs were analyzed. A total of 10 in 78 craniotomies (13%) detected HIS on DWI, which were all asymptomatic. Seventeen HIS were shown, 5 of which were located in the basal ganglia, 6 in the white matter, and 6 in the cortex. The volume and minimum value of apparent diffusion coefficient were 180.4 ± 31.2 mm3 and 0.56 ± 0.03 × 10−3 mm2/second, respectively. Radiographic outcomes at follow-up showed that 71% of HIS on DWI led to irreversible brain ischemia. The maximum diameter of aneurysms, atherosclerotic features of the aneurysm wall, and procedure-related factors were associated with DWI positivity.
The asymptomatic ischemic risk associated with microsurgical clipping was not low and most lesions were irreversible. Although the mechanism could be various, the use of clips for atherosclerosis of the aneurysm and/or parental vessels requires much attention.
A neuroendoscopic biopsy has become common for the diagnosis of ventricular tumors. However, its utility in patients with germ cell tumors (GCTs) has not been well discussed. We examined the ...usefulness and pitfalls of neuroendoscopic biopsies of intraventricular GCTs at a single institution.
We retrospectively studied 21 consecutive patients diagnosed with GCTs by a neuroendoscopic biopsy of the ventricular region via the lateral ventricle. We examined the localization of tumors, histologic diagnoses using biopsies, surgical complications, and consistency of the diagnosis at the latest follow-up.
Tumor specimens were obtained from a pineal lesion (n = 20), neurohypophysial lesion (n = 5), and lateral ventricular wall lesion (n = 2). In 5 patients, the specimens were obtained from multiple areas. The initial diagnoses were pure germinoma (n = 16), immature teratoma (n = 1), yolk sac tumor (n = 1), and mixed GCT (n = 3). Six of 21 patients needed a second transcranial removal of enhanced residual lesions in the course of the treatment. A discrepancy in the histologic diagnosis between 2 surgeries occurred in 3 patients: All 3 patients had a new diagnosis of teratoma component following transcranial surgery. No postoperative mortality or permanent morbidity related to the neuroendoscopic procedures was noted.
Neuroendoscopic biopsies are safe and useful for obtaining reliable histologic diagnoses in the management of GCTs. However, for GCTs with mixed histology, biopsies are susceptible to diagnostic errors, especially missing detecting a component of teratoma.
Perfusion computed tomography (PCT) reflects blood flow and capillary condition, which is valuable in assessing brain tumors. We evaluated PCT parameters at the tumor (t) and peritumoral (p) region ...to differentiate malignant brain tumors.
We performed PCT in 39 patients with supratentorial malignant brain tumors (22 glioblastomas, 6 lymphomas, 11 metastases). Regions of interests were placed manually at tumor, peritumoral region, and contralateral normal-appearing white matter. Cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and permeability surface (PS) were measured. These parameters were divided by those of contralateral normal-appearing white matter to normalize at tumor (relative rCBVt, rCBFt, rMTTt, rPSt) and peritumoral regions (rCBVp, rCBFp, rMTTp, rPSp). The parameters were evaluated with Mann–Whitney U test and receiver operating characteristics analyses. Stepwise analyses also were performed to select useful PCT parameters for differentiating these tumors.
The rCBFt and rCBVt of glioblastoma (GBM) were greater than those of primary central nervous system lymphoma (PCNSL) (P = 0.0005, 0.0002) and brain metastasis (METS) (P = 0.0044, 0.0028). The rMTTp of METS was greater than that of GBM and PCNSL (P = 0.0001, 0.0007). The combination of rCBVt and rPSt could differentiate GBM from other tumors with sensitivity and specificity of 81.8% and 94.1%. The combination of rCBFp and rMTTp could differentiate METS from other tumors with sensitivity and specificity of 90.9% and 82.1%.
Our study introduces and supports the usefulness of PCT parameters for differentiation among GBM, PCNSL, and METS. rCBVt and rPSt may be the best predictors of GBM. rCBFp and rMTTp may be the best predictors of METS.
•Differentiation among glioblastoma, primary central nervous system lymphoma, and brain metastasis is proposed.•Perfusion CT parameters are valuable for differentiating these tumors.•rCBV and rPS at tumor may be the best predictors of glioblastoma.•rCBF and rMTT at peritumoral region may be the best predictors of metastasis.
The molecular analysis revealed that supratentorial and infratentorial ependymomas were classified into 4 subgroups, RELA fusion positive, YAP-1 fusion positive, PF-A and PF-B 2. ...the importance of ...preoperative diagnosis in ependymoma is focused on. Recently, advanced MR imaging, such as diffusion-weighted imaging, perfusion analysis or single voxel proton MR spectroscopy, has been reported as the useful technique to determine the tumoral behavior. ...proton beam radiation therapy may be the prudent choice to treat this malignant tumor thereby preventing therapy-associated malignancy in the future. ...we here reported the advanced MR imaging characteristics of RELA fusion-positive ependymoma.
Abstract Objective It is sometimes difficult to make differential diagnosis between brain metastases and hemangioblastoma in posterior fossa. We assessed whether high b-value diffusion weighted image ...(DWI) at b-4000 could differentiate these tumors. Methods We acquired DWI at 3T magnetic resonance imaging (MRI) with b = 1000 and b = 4000 s/mm2 in histologically confirmed 12 patients of hemangioblastoma without von-Hippel Lindau disease and 16 patients of brain metastases originating at posterior fossa. Apparent diffusion coefficient (ADC) values were measured by manually placing regions of interest (ROIs) on ADC maps at the site of enhanced tumor confirmed on contrast-enhanced T1- weighed image. ADC was expressed as the minimum (ADCMIN ), mean (ADCMEAN ), and maximum (ADCMAX ) values. Results All the ADC values of hemangioblastoma were statistically higher than that of metastatic tumor in both b-1000 and b-4000 (p<0.0001 in ADCMIN , ADCMEAN and ADCMAX ; Mann - Whitney U-test). With the cut-off value at 0.6 × 10-3 mm2 /sec, positive predictive value of ADCMIN at b-4000 was higher than that of ADCMIN at b-1000 (100% vs 89.3%, logistic analysis) to differentiate hemangioblastoma from brain metastases. Moreover, we studied the pathological subtype of hemanigoblastoma and confirmed that ADCs (b-4000MIN ) of cellular subtype were statistically lower than those of reticular subtype (p=0.03, Mann-Whitney U-test). Conclusions High b-value DWI reflects diffusion more accurately than regular b-value. Our results showed that ADC calculation by high b value (b-4000) DWI at 3T MRI is clinically useful for differentiation hemangioblastoma from brain metastases.
ObjectiveSomatotropinomae are classified as densely and sparsely granulated adenomae, which typically exhibit a perinuclear pattern (PP) and a dot pattern (DP) in cytokeratin (CK) immunostaining ...respectively. Some exhibit a mixed pattern (MP). We studied the relationship between these somatotropinoma subtypes and their clinico-pathological features.MethodsThe study population consisted of 141 Japanese acromegalic patients. We evaluated their clinical presentation and their response to provocation tests with TRH and LHRH and to suppression (octreotide) test. Tumour tissues were subjected to immunostaining for CAM-5.2, MIB-1, CD34, E-cadherin (CDH1) and p53 (TP53). In 43 cases (30 non-DP and 13 DP), we analysed gsp mutations (constitutively activating mutations of the Gsα protein that is encoded by GNAS gene).ResultsThe 141 adenomae were categorised into three subtypes based on their CK staining patterns; 30 (21.3%) exhibited DP, 83 (58.9%) exhibited PP, and 28 (19.9%) exhibited MP. Compared with the other subtypes, DP adenomae were significantly larger, and their E-cadherin expression and response to TRH, LHRH and octreotide challenge were lower. The postoperative cure rate tended to be lower in DP adenomae. gsp mutations were detected in 25 of 43 cases examined (58.1%); 20 of the 30 non-DP (66.7%) and 5 of the 13 DP tumours (38.5%) were affected by the mutation.ConclusionDP somatotropinomae exhibit characteristic features. Compared with the non-DP subtypes, DP adenomae manifested a larger tumour size, a lower incidence of abnormal responses to TRH and LHRH challenge, a poor response to octreotide test and a lower expression of E-cadherin. gsp mutation was not exclusive for non-DP somatotropinomae.
Our goal was to localize lesions in poststroke depression patients using magnetic resonance imaging, based on the statistical parametric maps image analysis technique that can be used to combine ...image data from multiple participants and correlate these images with other data sets.
Magnetic resonance imaging acquisitions were obtained from 149 poststroke patients, who were assessed for affective and apathetic symptoms using the Hospital Anxiety and Depression Scale and the Apathy Scale, respectively. We created a statistical parametric map that displayed an association between lesion location and affective and apathetic symptoms.
Among the patients with higher depressive scores, the lesion overlap centered on the brainstem, left basal ganglia, and left frontal cortex. Among the patients with higher apathy scores, the lesion overlap centered on the brainstem and bilateral striatum. The overlap lesion for both affective and apathetic depression centered mainly on the brainstem; however, the two types of depression often did not overlap.
Two core symptoms that can occur after stroke, affective and apathetic symptoms, appear to be associated with different monoaminergic neuroanatomic pathways (serotonergic and dopaminergic).
This study was designed to examine the correlation between damage to the basal ganglia or frontal lobe and depression status (both affective and apathetic dimensions) in 243 stroke patients. We ...assessed the affective dimension in post-stroke depression (PSD) using the Zung Self-rating Depression Scale (SDS) and the apathetic dimension in PSD using the apathy scale (AS). We classified basal ganglia or frontal lobe damage into four groups: no damage, damage to the left side only, damage to the right side only, and damage to both sides. Affective and/or apathetic PSD was found in 126 patients (51.9%). The severity of affective depression (SDS score) was associated with left frontal lobe (but not basal ganglia) damage, and that of apathetic depression (AS score) was related to damage to the bilateral basal ganglia (but not to the frontal lobe). The anatomical correlates of PSD differ depending on the PSD dimension (affective or apathetic) and may explain interstudy differences regarding the association between lesion location and type of PSD.
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