Purpose
The improving knowledge of interactions between meningiomas and progestin refines the management of this specific condition. We assessed the changes over time of the management of ...progestin-associated meningiomas.
Methods
We retrospectively studied consecutive adult patients who had at least one meningioma in the context of progestin intake (October 1995–October 2018) in a tertiary adult Neurosurgical Center.
Results
71 adult women with 125 progestin-associated meningiomas were included. The number of progestin-associated meningioma patients increased over time (0.5/year before 2008, 22.0/year after 2017). Progestin treatment was an approved indication in 27.0%. A mean of 1.7 ± 1.2 meningiomas were discovered per patient (median 1, range 1–6). Surgery was performed on 36 (28.8%) meningiomas and the histopathologic grading was WHO grade 1 in 61.1% and grade 2 in 38.9%. The conservative management of meningiomas increased over time (33.3% before 2008, 64.3% after 2017) and progestin treatment withdrawal increased over time (16.7% before 2008, 95.2% after 2017). Treatment withdrawal varied depending on the progestin derivative used (88.9% with cyproterone acetate, 84.6% with chlormadinone acetate, 28.6% with nomegestrol acetate, 66.7% with progestin derivative combination). The main reason for therapeutic management of meningiomas was the presence of clinical signs. Among the 54 meningiomas managed conservatively for which the progestin had been discontinued, MRI follow-up demonstrated a regression in 29.6%, a stability in 68.5%, and an ongoing growth in 1.9% of cases.
Conclusions
Conservative management, including progestin treatment discontinuation, has grown over time with promising results in terms of efficacy and safety.
FET:CREB fusions have been described in a variety of tumors from various phenotypes. Recently, these fusion transcripts were reported in intracranial tumors, variably named intracranial mesenchymal ...myxoid tumors or angiomatoid fibrous histiocytomas. Controversy remains concerning the terminology for these tumors. Here, we report 11 cases of central nervous system mesenchymal tumors with proven FET:CREB fusion. Most DNA methylation profiles were not classifiable using the Heidelberg Brain Tumor or Sarcoma Classifier (v11b4/v12.2). However, by using unsupervised t‐SNE and hierarchical clustering analyses, six of the cases constituted a distinct cluster. The remaining four tumors showed no obvious relation to any of the other referenced classes but were close to the clusters of extra‐CNS angiomatoid fibrous histiocytomas (n = 1), clear cell sarcomas (n = 1), or solitary fibrous tumors (n = 2). Our findings confirm that intracranial FET:CREB‐fused tumors do not represent a single molecular tumor entity, although most samples clustered close to each other, indicating the existence of a distinct epigenetic group that could potentially be partially masked by the low number of cases included. Further analyses are needed to characterize intracranial FET:CREB fused‐defined tumors in more detail.
Our series includes 11 cases of central nervous system mesenchymal tumors with proven EWSR1 fusion with clinical, histopathological, genetic and epigenetic analyses. Our findings show that intracranial EWSR1:CREB fused‐defined tumors do not represent a single molecular tumor entity, but instead largely cluster into a new DNA methylation class corresponding to the suggested new terminology of “primary intracranial myxoid sarcoma, with EWSR1‐fusion”.
Neuroimaging and especially MRI has emerged as a necessary imaging modality to detect, measure, characterize and monitor brain tumours. Advanced MRI sequences such as perfusion MRI, diffusion MRI and ...spectroscopy as well as new post-processing techniques such as automatic segmentation of tumours and radiomics play a crucial role in characterization and follow up of brain tumours. The purpose of this review is to provide an overview on anatomical and functional MRI use for brain tumours boundaries determination and tumour characterization in the specific context of radiotherapy. The usefulness of anatomical and functional MRI on particular challenges posed by radiotherapy such as pseudo progression and pseudo esponse and new treatment strategies such as dose painting is also described.
Les avancées en neuro-imagerie, principalement liées au développement de l’IRM, ont rendu cette modalité centrale dans la prise en charge des patients porteurs de tumeur cérébrale. L’IRM, par son approche anatomique, permet de détecter, localiser et caractériser les lésions. L’application de séquences avancées d’IRM de type imagerie de perfusion, de spectroscopie ou de diffusion, ainsi que les nouveaux post-traitements permettant une segmentation ou une caractérisation automatique des lésions, apportent de nouvelles possibilités pour affiner la caractérisation des tumeurs tant au moment du diagnostic initial que lors dde la radiothérapie et du suivi. L'objectif de cette revue de littérature est de donner un aperçu de l’utilisation des imageries IRM anatomique et fonctionnelle utilisées pour la détermination des contours des différentes tumeurs cérébrales dans le contexte particulier de la radiothérapie. L’utilité de l’IRM anatomique et fonctionnelle est également examinée, en portant une attention particulière aux défis posés par la radiothérapie, tels que la pseudoprogression et la pseudoréponse, ainsi que par de nouvelles stratégies de traitement personnalisées, comme la dose painting.
L’électroconvulsivothe?rapie (ECT), traitement le plus efficace de la dépression pharmaco-résistante, induit une augmentation du volume hippocampique attribuée à une neurogénèse. Un modèle ...mutli-compartimental de diffusion comme NODDI (Neurite Orientation Dispersion and Density Imaging) permettrait d’étudier les modifications microstructurales hippocampiques ECT-induites.
Étude prospective longitudinale monocentrique. 43 patients (26 femmes, 54.07 ans ± 18.09). Critères d'inclusion : dépression sévère (DSM-5) et indication d'ECT. Trois évaluations: initiale (V1), après 5 sessions d'ECT (V2), dans les 14 jours post-traitement (V3). Évaluation comprenant (1) IRM encéphalique 3T avec 3D SPGR T1 et diffusion multi-shell (b=200/1500/2500s/mm2, 30/45/60 directions, résolution 2mm isotropique), (2) scores de dépression dont MADRS. Extraction des (1) volumes hippocampiques par segmentation FreeSurfer des images T1 et (2) paramètres de diffusion régionaux avec la Ginkgo toolbox : diffusivités axiale, radiale et moyenne (DA, DR, DM), fraction d'anisotropie (FA), FA généralisée (GFA), isotropique (Fiso), index de densité de neurites (NDI) et d'orientation et dispersion des neurites (ODI). Modèle linéaire mixte évaluant les changements volumique et de diffusion hippocampiques (variables dépendantes), incluant sexe, volume initial (facteurs inter-sujets) et temps (intra-sujet). ANOVA pour étude de corrélation avec réponse/sévérité clinique.
105 IRM obtenues à V1 (n=43), V2 (n=33) and V3 (n=29). Augmentation significative et bilatérale des volumes hippocampiques observée dès V2. Diminution de la GFA bilatéralement entre V1-V2. Diminution unilatérale gauche de la DM et bilatérale de la DA entre V1-V3. Augmentation unilatérale droite du NDI entre V1-V3, diminution de la Fiso bilatéralement entre V1-V2, augmentation bilatérale de l'ODI dès V2. Pas de corrélation avec la sévérité initiale ou la réponse clinique post-ECT.
Après ECT, l'analyse des paramètres anatomiques et de diffusion hippocampique en IRM montre une augmentation bilatérale du volume, une diminution des GFA, DA et Fiso, une augmentation des NDI et ODI, compatibles avec une accélération de la neurogénèse hippocampique.
Individualized patient selection for mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) and large ischemic core (LIC) at baseline is an unmet need. We tested the hypothesis ...that assessing the functional relevance of both infarcted and hypoperfused brain tissue would improve the selection framework of patients with LIC for MT.
We performed a multicenter, retrospective study of adults with LIC (ischemic core volume >70 mL on MRI diffusion-weighted imaging) with MRI perfusion treated with MT or best medical management (BMM). Primary outcome was 3-month modified Rankin Scale (mRS), favorable if 0-3. Global and regional eloquence-based core perfusion mismatch ratios were derived. The predictive accuracy for clinical outcome of eloquent regions involvement was compared in multivariable and bootstrap random forest models.
A total of 138 patients with baseline LIC were included (MT n = 96 or BMM n = 42; mean age ± SD, 72.4 ± 14.4 years; 34.1% female; mRS 0-3: 45.1%). Mean core and critically hypoperfused volume were 100.4 mL ± 36.3 mL and 157.6 ± 56.2 mL, respectively, and did not differ between groups. Models considering the functional relevance of the infarct location showed a better accuracy for the prediction of mRS 0-3 with a c statistic of 0.76 and 0.83 for logistic regression model and bootstrap random forest testing sets, respectively. In these models, the interaction between treatment effect of MT and the mismatch was significant (
= 0.04). In comparison, in the logistic regression model disregarding functional eloquence, the c statistic was 0.67 and the interaction between MT and the mismatch was insignificant.
Considering functional eloquence of hypoperfused tissue in patients with a large infarct core at baseline allows for a more precise estimation of treatment expected benefit.
This study provides Class II evidence that, in patients with AIS and LIC, considering the functional eloquence of the infarct location improves prediction of disability status at 3 months.
Carmustine wafers can be implanted in the surgical bed of high-grade gliomas, which can induce surgical bed cyst formation, leading to clinically relevant mass effect. An observational retrospective ...monocentric study was conducted including 122 consecutive adult patients with a newly diagnosed supratentorial glioblastoma who underwent a surgical resection with Carmustine wafer implantation as first line treatment (2005–2018). Twenty-two patients (18.0%) developed a postoperative contrast-enhancing cyst within the surgical bed: 16 surgical bed cysts and six bacterial abscesses. All patients with a surgical bed cyst were managed conservatively, all resolved on imaging follow-up, and no patient stopped the radiochemotherapy. Independent risk factors of formation of a postoperative surgical bed cyst were age ≥ 60 years (
p
= 0.019), number of Carmustine wafers implanted ≥ 8 (
p
= 0.040), and partial resection (
p
= 0.025). Compared to surgical bed cysts, the occurrence of a postoperative bacterial abscess requiring surgical management was associated more frequently with a shorter time to diagnosis from surgery (
p
= 0.009), new neurological deficit (
p
< 0.001), fever (
p
< 0.001), residual air in the cyst (
p
= 0.018), a cyst diameter greater than that of the initial tumor (
p
= 0.027), and increased mass effect and brain edema compared to early postoperative MRI (
p
= 0.024). Contrast enhancement (
p
= 0.473) and diffusion signal abnormalities (
p
= 0.471) did not differ between postoperative bacterial abscesses and surgical bed cysts. Clinical and imaging findings help discriminate between surgical bed cysts and bacterial abscesses following Carmustine wafer implantation. Surgical bed cysts can be managed conservatively. Individual risk factors will help tailor their steroid therapy and imaging follow-up.
Age estimation is a key factor for identification procedure in forensic context. Based on anthropological findings, degenerative changes of the sternal extremity of the 4th rib are currently used for ...age estimation. These have been adapted to post-mortem computed tomography (PMCT). The aim of this study was to validate a post-mortem computed tomography method based on a revision of the Iscan’s method on a French sample. A total of 250 PMCT (aged from 18–98 years (IQR 36–68 years, median 51 years); 68 (27%) females) from the Medicolegal Institute of Paris (MLIP) were analyzed by two radiologists. The sternal extremity of 4th right rib was scored using method adapted from Iscan et al. Weighted
κ
was used to evaluate intra- and inter-observer reliability and Spearman correlation was performed to evaluate relationship between age and score. Confidence intervals for individual prediction of age based on 4th rib score and sex were computed with bootstrapping. The intra-observer reliability and inter-observer reliability were almost perfect (weighted
κ
= 0.85 95%CI: 0.78–0.93 and 0.82 95%CI 0.70–0.96 respectively). We confirmed a high correlation between the 4th rib score and subject age (rho = 0.72,
p
< 0.001), although the confidence intervals for individual age prediction were large, spanning over several decades. This study confirms the high reliability of Iscan method applied to PMCT for age estimation, although future multimodal age prediction techniques may help reducing the span of confidence intervals for individual age estimation.
Trial registration: INDS 0,509,211,020, October 2020, retrospectively registered.
Purpose
In patients with ICA stenosis, increased peak systolic velocity is a marker of stenosis at risk of ischemic stroke. 4DFlow MRI is a reproducible technique to evaluate velocities in ICA ...stenosis, although it seems to underestimate velocities as compared with Doppler ultrasonography. The purpose of our study was to confirm that velocities were underestimated on a new set of data acquired with a clinical 4DFlow sequence, and to devise optimal acquisition parameters for ICA stenosis exploration based on a numerical simulation.
Methods
After review board approval, 15 healthy controls and 12 patients presenting ICA stenosis were explored with Doppler ultrasonography and 4DFlow MRI. We created a 2-dimensional simulation of ICA stenosis and its corresponding 4DFlow acquisition, and compared its mean peak systolic velocity underestimation to real MRI and Doppler. We then simulated the acquisition for voxel size ranging from 0.5 to 1.25 mm and number of phases per cardiac cycle ranging from 10 to 25.
Results
On acquired data, 4DFlow MR underestimated peak systolic velocities (mean difference between Doppler and 4DFlow: − 35 cm/s), especially high velocities. With spatial and temporal resolutions equivalent to MR acquisition, our simulation yielded similar underestimation (mean difference: − 31 cm/s,
P
= 0.30). Simulations showed that 0.7-mm resolution and 20 phases per cardiac cycle would be necessary to record peak systolic velocities up to 250 cm/s.
Conclusion
Higher spatial resolution can provide accurate peak systolic velocities measurement with 4DFlow MRI, thus allowing better ICA stenosis assessment. Further studies are needed to validate the proposed parameters.
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