bluuebunny/crossref_metadata_2025 huggingface dataset:
NIMG-57. EMBEDDED GRAPH DERIVED FROM PSEUDO-RESTING-STATE FUNCTIONAL MRI CAN PREDICT COGNITIVE IMPAIRMENT IN GLIOMA
Authors: Wang Chencai , Cho Nicholas , Van Dyk Kathleen , Sanvito Francesco , Oshima Sonoko , Yao Jingwen , Lai Albert , Salamon Noriko , Cloughesy Timothy , Nghiemphu Phioanh , Ellingson Benjamin
Published: November 2024

Resting-state brain network analyses are of great interest in studying the neurocognition and measuring the functional connectivity (FC) patterns of glioma patients. However, resting-state functional MRI (rs-fMRI) is not assessed in clinical routine due to the scan time and cost. The current study used pseudo-resting-state functional MRI (pseudo-rs-fMRI) derived from dynamic susceptibility contrast (DSC) perfusion MRI to predict cognitive impairment in glioma. 37 glioma patients were enrolled consecutively in the current study with DSC perfusion MRI acquired and neurocognition assessed, where 24 glioma patients also got rs-fMRI collected. The pseudo-rs-fMRI was created by voxel-wise subtracting the Gamma-variate modeled signal of contrast agent bolus from the original DSC perfusion signal. Following the pre-processing of pseudo-rs-fMRI and full rs-fMRI, the functional connectivity network (FCN) was established for each patient. Graph embedding was implemented to learn and extract features of each node in the binarized FCN, and the decision tree classification algorithm was applied to distinguish cognitive impairment. FCNs of 24 patients with DSC perfusion and rs-fMRI acquired were used to train the model, and FCNs of 13 patients with only DSC perfusion MRI acquired were used to test the model. The AUC (area under the receiver operating characteristic curve) was used to evaluate the model’s performance. The similarity and mean-square-difference between average FCNs extracted from rs-fMRI and pseudo-rs-fMRI were 0.6769 and 0.0263, respectively. Classifier trained using 24 FCNs of pseudo-rs-fMRI has an AUC of 0.750 in identifying cognitively impaired patients in the testing cohort. Combining FCNs of both rs-fMRI and pseudo-rs-fMRI to train the classifier resulted in a higher AUC of 0.833 in the testing cohort. To summary, DSC perfusion MRI-derived pseudo-rs-fMRI can be used to predict cognitive impairment in patients with gliomas. External validation would be required.
NIMG-62. SEX-DISTINCT TRANSCRIPTOMIC SIGNATURES UNDERLY MRI-DEFINED EDEMA PATTERNS IN HUMAN GLIOMAS
Authors: Jackson Pamela , Curtin Lee , Singleton Kyle , Mrugala Maciej , Zimmerman Richard , Bendok Bernard , Canoll Peter , Swanson Kristin
Published: November 2024

Magnetic resonance imaging (MRI) is key to clinically managing brain tumor patients, however connecting the biology to imaging remains challenging. We previously developed a two-compartment model of MRI signal intensity to quantitatively estimate relative edema abundance from T2-weighted MRIs. Using this model, we previously identified the fatty acid metabolism (FAM) and oxidative phosphorylation (OxPhos) pathways as sex-distinct, with both pathways amplified for high edema in males and low edema in females. The purpose of this project was to further delineate sex-distinct biology associated with MRI-estimated brain tumor edema abundance. We analyzed 179 multiregional samples (Female: 75; Male: 104) from 55 high grade glioma patients (Female: 21; Male: 34) for bulk RNA-Seq. Patients’ pre-surgical multiparametric MRIs were preprocessed and segmented for abnormal regions and normal tissue. Utilizing the segmentations and preprocessed images we estimated the relative fractions of extracellular and intracellular space based on the edema mathematical model. Samples were characterized by their edema scores, which were analyzed using differential expression for high and low edema, gene set enrichment analysis (GSEA) using MSigDB hallmarks, and leading edge interpretation. Based on transcriptomic leading edge analyses of high and low edema samples from sex-separated cohorts, we identified common and sex-distinct enrichment of the FAM and OxPhos pathways underlying edema patterns. Of the OxPhos pathway leading edge genes, 45 were common, 36 were unique to females, and 66 were unique to males. Of the FAM pathway leading edge genes, 8 were common, 39 were unique to females, and 29 were unique to males. Notably, expression of both IDH1 and IDH2 were increased for males in regions of high edema in the OxPhos pathway. IDH3a was decreased for females in regions of low edema in the OxPhos pathway. These data suggest that there may be sex-distinct metabolism underlying MRI measurable edema formation.
NIMG-66. DEFINING PROGRESSIVE DISEASE: LOCALIZING VOXEL-AT-RISK ON MAGNETIC RESONANCE IMAGING USING DEEP LEARNING
Authors: Freeman Nicolas , Pan Ian , Youssef Gilbert , Wen Patrick , Huang Raymond
Published: November 2024

Follow-up magnetic resonance imaging (MRI) of post-treatment glioblastoma (GBM) can be diagnostically challenging in differentiating progressive disease (PD) from coexisting treatment-related changes. The study aim was to train a machine learning model using multiple MRI timepoints from treated GBM patients with subsequent PD or at least six months of tumor-like, persistently stable disease (SD) to estimate PD risk. A retrospective, post-treatment GBM cohort (n=189) with 453 timepoints was identified with available MRI sequences (T1-weighted with and without contrast, T2-weighted, and fluid-attenuated inversion recovery). PD cases (n=154) showed new, enhancing PD followed by death within 3-6 months; timepoints included the MRI on the PD diagnosis date and the one directly prior. SD cases (n=35) exhibited stable, tumor-like enhancement over timepoints. Cases underwent voxel-wise annotation of PD versus SD. A multiclass, three-dimensional nnU-Net was trained to label voxels as PD, SD, or neither using timepoint sequences with five-fold cross-validation. Model performance was assessed using the ratio of predicted PD/SD voxels compared to each case’s actual PD or SD status. Classification accuracy of PD versus SD status, PD case-wise sensitivity and specificity, and a Receiver Operating Characteristic (ROC) analysis using the PD/SD ratio were presented. The five-fold model ensemble was evaluated on a holdout test set. Validation set performance showed 74.3% accuracy, 0.73 PD case-wise sensitivity, and 0.80 specificity. The holdout set exhibited 79.8% accuracy, 0.81 sensitivity, and 0.78 specificity for PD cases. The ROC analysis showed an area under the curve of 0.80 and 0.83 on the validation and holdout sets, respectively. The model showed high performance and classification accuracy in predicting which voxels were at risk of PD in post-treatment GBM cases. The model also differentiated between PD and SD regions. The model’s predicted PD/SD ratio may be clinically used to stratify patients’ PD risk.
NIMG-70. COMPARISON OF VOLUMETRIC AND CROSS-SECTIONAL MEASUREMENTS IN DIFFUSE MIDLINE GLIOMAS: RETHINKING RESPONSE ASSESSMENT
Authors: Khalili Neda , Khalili Nastaran , Gandhi Deep , Franson Andrea , Jain Paarth , Anderson Hannah , Tu Wenxin , Haldar Shuvanjan , Familiar Ariana , Storm Phillip , Ware Jeffrey , Resnick Adam , Vossough Arastoo , Nabavizadeh Ali , Fathi Kazerooni Anahita
Published: November 2024

BACKGROUND

The Response Assessment in Pediatric Neuro-Oncology (RAPNO) criteria, which are based on bidimensional or cross-sectional product (CP) measurements of tumor size, are the standard for assessing treatment response in diffuse midline glioma (DMG). This study aims to investigate the correlation between CP and volumetric measurements in progressive disease (PD) and compare their prognostic impact in pediatric patients with DMG.

METHODS

We retrospectively reviewed clinical and imaging data from 27 subjects with newly diagnosed DMG, encompassing 16 subjects from the PNOC003 and PNOC007 clinical trials and 11 subjects from the Children’s Hospital of Philadelphia. Tumors were segmented using a pretrained pediatric-specific autosegmentation model followed by manual revisions. Tumor volume and CP measurements were automatically derived from the outlined tumor. Cox regression analysis was used to compare the performance of CP and volumetric measurements in predicting overall survival (OS). The correlation between CP and volumetric thresholds for PD was assessed by linear regression. Comparison of survival of patients classified as PD versus non-PD by CP and volumetric measurements at 7 months post-baseline scan was performed using log-rank analysis.

RESULTS

Cox regression analysis demonstrated that volumetric measurements were significantly associated with OS (p=0.04), whereas CP measurements were not a significant predictor (p=0.07). An approximate 55% increase in segmented volume corresponded to a 25% increase in CP, which is the definition of PD according to RAPNO criteria (R2 = 0.71). At 7 months, volumetric classification of PD more accurately predicted survival than the CP method (p=0.06 for volumetric vs 0.14 for CP).

CONCLUSION

Our study showed that volumetric measurements are better predictors of survival compared to bidimensional measurements. We are extending this analysis to a larger sample size, examining survival at additional time points, and incorporating other factors influencing OS, such as treatment approaches.
NIMG-72. VOXEL-WISE, MULTIVARIABLE, COX PROPORTIONAL HAZARD STATISTICAL PARAMETER MAPPING TO INVESTIGATE THE INTERPLAY BETWEEN TUMOR LOCATION, PROGNOSTIC VARIABLES, AND EXPERIMENTAL TREATMENT IN A PHASE 3 TRIAL OF NEWLY-DIAGNOSED GLIOBLASTOMA TREATED WITH CHEMORADIATION WITH OR WITHOUT BEVACIZUMAB
Authors: Sanvito Francesco , Raymond Catalina , Abrey Lauren , Garcia Josep , Simmons Brian , Chinot Olivier , Saran Frank , Nishikawa Ryo , Henriksson Roger , Mason Warren , Wick Wolfgang , Cloughesy Timothy , Ellingson Benjamin
Published: November 2024

BACKGROUND

Tumor location is known to impact overall survival (OS) in glioblastoma. However, there is a lack of quantitative tools for studying the interplay between tumor location, prognostic variables, and treatments. In the current study we develop a voxel-wise statistical parameter mapping technique using a multivariable Cox regression model to describe the influence of tumor location on treatment effects in newly diagnosed glioblastoma.

METHODS

598 newly diagnosed glioblastoma patients from the phase 3 AVAglio trial were studied. Areas of T2/FLAIR hyperintensity and resection cavities on post-surgical MRI scans were segmented and aligned to MNI atlas space. Voxel-wise Cox proportional hazards models for OS were run for each image voxel and included tumor presence in a specific voxel, age, MGMT promoter methylation, baseline tumor volume, and treatment (chemoradiation with or without bevacizumab). Results. After adjusting for other variables, tumor location was an independent predictor of favorable OS for tumors with involvement in the right prefrontal cortex (p<0.05, HR ranging ~0.48–0.65) and a predictor of shorter OS for tumors in the left mesial/basal temporo-occipital areas (p<0.05, HR ~3–6.2) and in the left hemisplenium of the corpus callosum (p<0.05, HR ~2.5–3). Baseline tumor volume (HR ~4–6 x10-6), MGMT status (HR ~0.38–0.41), and age (HR ~1.020–1.025) were significative predictors regardless of location (p<0.05 in all locations). Interestingly, chemoradiation plus bevacizumab treatment showed a favorable OS compared with chemoradiation alone for tumors with involvement in the right corticospinal tract, right motor and sensory cortices, and left hemisplenium of the corpus callosum (p<0.05, HR ~0.82).

CONCLUSIONS

Tumor involvement in the prefrontal cortex is associated with favorable prognosis, while tumors in mesial/basal temporo-occipital areas or splenium of the corpus callosum are associated with shorter OS. Chemoradiation plus bevacizumab may improve OS for tumors involving eloquent motor areas and the corticospinal tract.
NIMG-78. THE ROLE OF FDG PET/CT IN MANAGING DIFFUSE MIDLINE GLIOMA WITH H3K27M MUTATION: A CASE STUDY AND PATHOLOGICAL CORRELATION
Authors: Choi Yoon , Kong Xiao-Tang
Published: November 2024

The clinical utility of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the management of high grade gliomas has been a topic of ongoing debate, with limited cases reported that correlated FDG PET/CT findings with pathology, particularly in diffuse midline glioma with HdK27M mutation cases. We present the case of a 24-year-old male patient with diffuse midline glioma with H3K27M mutation centered in the left thalamus. Head FDG PET/CT was used for clinical management decisions with pathological correlation. Patient had stable follow up brain magnetic resonance images(MRIs) after initial Stupp protocol treatment comprised 6-week radiation therapy with concurrent temozolomide, followed by 12 cycles of adjuvant temozolomide. Despite stable MRI scans, subsequent evaluation using FDG PET/CT demonstrated a high standardized uptake value (SUV) of 13.8 that prompted craniotomy and partial resection of the lesion to confirm tissue diagnosis. Pathological findings confirmed the persistence of densely cellular malignant glioma, but with Ki-67 proliferation index of 4-5%. Following the surgery, the patient was closely monitored with surveillance MRIs for approximately four months post-surgery and follow up MRI’s showed slow growth of the tumor prompting additional therapeutic interventions. This case is an example of FDG PET/CT and pathological correlation and highlights the potential role of FDG PET/CT as an adjunctive imaging tool in the management of high grade gliomas.
NIMG-81. PREDICTING TUMOR PROGRESSION WITH FIBER DENSITY-WEIGHTED WHITE MATTER PATHLENGTH MAPS IN PATIENTS WITH GLIOBLASTOMA
Authors: Liu Bo , Ngan Tiffany , Jakary Angela , Tran Nate , Rowley Paul , Braunstein Steve , Morin Olivier , Lin Hui , Lupo Janine
Published: November 2024

PURPOSE

Although histopathological evidence indicates that glioma cells preferentially migrate along large white-matter bundles, standard-of-care (SOC) radiation therapy (RT) planning remains an isotropic expansion of the anatomical lesion. We hypothesize that anisotropic expansion of RT target volumes along white-matter pathways using fiber density-weighted, white-matter pathlength maps (DW-WMPLMs) derived from diffusion tensor imaging (DTI) could improve the prediction of tumor cell migration beyond surgical margins by a deep learning model compared to SOC clinical target volumes (CTVs).

METHODS

DTI and anatomical MRI from 118 patients newly-diagnosed with glioblastoma were retrospectively analyzed with anatomical imaging from post-surgical resection and latest progression scan before intervention. Parallel-transport tractography seeded from the pre-surgery T2-lesion was used to estimate white-matter fiber propagation. Fibers that intersected with the resection cavity were weighted by their density to control the length of expansion and create a DW-WMPLM that was used together with T2-FLAIR and T1-post-contrast images as inputs to a novel 3D-Swin-UNetR network, trained to predict the recurrence region using 4-fold cross-validation and evaluated in a holdout test-set (95/23 CV/test). New weighted-overlap, coverage, and sparing indices were introduced to evaluate coverage of the progressed lesion and healthy brain excluded.

RESULTS

52% of patients had progression outside the standard 2cm-isotropic CTV margin, motivating the need for anisotropic CTVs. Our novel DW-WMPLMs had 87±20% and 83±18% overlap with contrast-enhancing and T2-lesion progression, respectively. The deep-learning model trained with DW-WMPLMs and anatomical images achieved 19% and 56% higher Dice and weighted-overlap indices compared to the isotropic 2cm-CTV(p<0.02), with less normal brain included.

CONCLUSION

This study demonstrates the feasibility and benefit of incorporating a novel metric of white-matter track characterization into deep learning progression prediction models of glioblastoma for RT-planning. Current work is validating findings in a prospective cohort acquired immediately prior to RT and incorporating other imaging metrics.
NIMG-84. BELZUTIFAN REDUCTION OF CEREBRAL BLOOD FLOW IN VHL-ASSOCIATED HEMANGIOBLASTOMA PREDICTS RESPONSE TO TREATMENT
Authors: Persad Amit , Yagmurlu Ayse Banu , Park David , Zamarud Aroosa , Huang Yuhao , Hori Yusuke , Chang Steven , Iv Michael
Published: November 2024

Hemangioblastoma (HMB) is a vascular-origin tumor occurring primarily in the cerebellum. Treatment typically involves surgical resection of the solid part of the tumor or stereotactic radiosurgery. An emerging treatment for hemangioblastoma is belzutifan (BZF), a hypoxia-inducible factor 2a (HIF2a) inhibitor. A recent trial found BZF to control hemangioblastoma in patients with von Hippel Lindau (vHL) syndrome. Perfusion MRI techniques including arterial spin labelling (ASL) and can be used to determine relative cerebral blood flow (rCBF). No prior studies have investigated rCBF in hemangioblastoma with relation to belzutifan, and the mechanism of action of belzutifan on hemangioblastoma is not well understood. Here, we aim to measure the response in rCBF in patients with vHL-associated hemangioblastoma treated with belzutifan. This retrospective cohort study constituted a group of seven patients with vHL-associated hemangioblastoma treated with Belzutifan at a daily oral dose of 120mg. Perfusion MRI with ASL sequences were acquired as part of the tumor imaging protocol. We quantified rCBF of the tumors prior to treatment, following intiation of BZF, and at most recent follow-up. Statistics were performed using R studio. The long axis diameter, volume of the solid tumor, rCBF mean, rCBF max, N mean, N max of lesions all decreased after Belzutifan treatment (p<0.001). While the long axis diameter of the cyst in cystic lesions did not show statistically significant change, the volume of cysts decreased significantly on Belzutifan (p=0.016). Spearman’s rank correlation analysis demonstrated association between change in rCBF mean, rCBF max, N mean and N max to % reduction in tumor volume. In addition, change in rCBF mean, change in rCBF max and change in N max all showed statistically significant association on multiple linear regression. Finally, early change in CBF and N predicted further volumetric response to treatment with belzutifan. We demonstrate that vHL-associated hemangioblastoma demonstrates decrease in rCBF in conjunction with and predictive of decreased volume following treatment with belzutifan.
NIMG-89. MULTI-THRESHOLD VOLUMETRIC MAPPING OF18F-FLUOROETHYLTYROSINE POSITRON EMISSION TOMOGRAPHY (18F-FET PET) IMPROVES TUMOR DETECTION IN PRIMARY MALIGNANT BRAIN TUMOR PATIENTS
Authors: Grega Shaun , Gauger Andrew , Larson Matthew , Nevel Kathryn , Territo Wendy , Green Mark , Veronesi Michael
Published: November 2024

PURPOSE

The purpose of this study was to determine whether additional volumetric measurements yielded significant prognostic information than typically reported tumor-to-brain ratio thresholds (TBRmax) alone for accurately distinguishing progressive disease from treatment induced changes.

METHODS

Hybrid 18F-FET PET/MRI was obtained on pathology confirmed high-grade glioma in sixty patients from August 6th, 2022 to March 9th, 2023 at one US institution. We compared the diagnostic accuracy of various TBR thresholds and volumetric measurement combinations in identifying progressive disease. Specifically, we assessed TBR >1.6, 2.0, 2.5, 3.0, 3.5, 4, 4.5, and 5.0 alone and in combination with volumetric measurements greater than 1 mL. Survival data for all patients were analyzed using Kaplan-Meier curves.

RESULTS

Our analysis revealed that TBR > 2.5 and >1 mL yielded the highest diagnostic accuracy (100%) in distinguishing progressive disease from treatment induced changes. This was followed by the combination TBR >2.0 and >1 mL (98%), TBR > 2.5 alone (98%), TBR > 2.0 alone (86%), TBR >1.6 and >1 mL (84%), and TBR >1.6 alone (77%). TBR >3.0, 3.5, 4.0, 4.5, and 5.0 with and without volumetric measurements showed accuracies of 100%. Kaplan-Meier survival analysis showed significant results for all thresholds: TBR >1.6 alone (p = 0.047), TBR >1.6 and 1 mL (p = 0.003), TBR > 2.0 alone (p = 0.019), TBR >2.0 and >1 mL (p < 0.001), TBR >2.5 alone (p < 0.001), and TBR >2.5 and >1 mL (p = 0.002).

CONCLUSION

Our findings suggest that although TBRmax > 2.5 alone continues to be a reliable metric for distinguishing progressive disease from treatment induced changes, TBRmax >2.5 when volume is greater than 1 mL shows the greatest accuracy in detecting disease progression. Understanding the volumetric contribution to static FET TBRmax is important for tumor response assessment at TBRmax thresholds above 1.6 TBRmax.
NCMP-04. IMPLANTATION METASTASIS FOLLOWING BIOPSY OF THALAMIC GERMINOMA – A CASE REPORT AND REVIEW OF LITERATURE
Authors: Saundt Yu Llarx , Malilay Oliver Ryan , Navarro Joseph Erroll
Published: November 2024

Germ cell tumors commonly develop in the pineal and suprasellar regions, with the most common germ cell tumor being germinomas. In this report, a 22-year-old male presented with progressive right-sided weakness and his imaging was consistent a thalamic high grade glioma. A stereotactic biopsy was performed, revealing a germinoma, but radiation therapy was not done and patient was lost to follow up. He was readmitted due to ulcerative tumor growth at the previous skin incision, and imaging revealed tumor progression with implantation metastasis along the tract of the previous biopsy. The scalp tumor was excised and histopathologic studies confirmed that it was proliferation of the previous germinoma. He was discharged well but was unfortunately unable to follow up at the clinic. Thalamic germinomas are difficult to diagnose and treat because of their rarity. Here we underscore the importance of careful patient selection, precise biopsy techniques, thorough postoperative management and close radiographic surveillance to minimize the risk of implantation metastasis and promptly treat it if it occurs.
NCMP-06. GENOTYPE AND SEX IMPACT MEMORY FUNCTION AFTER BRAIN IRRADIATION
Authors: Oyewole Aboyeji , Yang Joyce , Lee Megan , Sei Yoshi , Sims Jeffrey , Bisoyi Padmini , Nakamura Ken , Nakamura Jean
Published: November 2024

PURPOSE/OBJECTIVE

Cognitive changes are a serious complication that can occur after brain radiotherapy. There is a need to better understand which individuals are more susceptible to develop strategies to preserve their function. The apolipoprotein E type 4 allele (APOEe4) APOE4 is the most prevalent genetic risk factor for Alzheimer Disease. We hypothesized that APOE genotype influences memory function after a subtherapeutic dose of whole brain irradiation in male and female mice.

MATERIALS/METHODS

Age-matched adult female and male mice engineered with either human APOE3 or APOE4 gene knocked-in were randomized to no treatment or whole brain irradiation (0 Gy or 5 Gy x 2), then evaluated with longitudinal neurobehavioral tests of learning, memory, pain threshold and anxiety. We performed immunohistochemical analyses of mouse brain sections at 1 month and at 4 months post-radiation to quantify extracellular amyloid beta plaques and other neuropathologic hallmarks associated with neurodegeneration.

RESULTS

Neurobehavioral testing identified significant sex and genotype-dependent changes in memory and anxiety measures developing longitudinally after brain irradiation. At baseline (unirradiated), APOE4 mice (male and female) performed worse on multiple memory measures. However after irradiation, sex and genotype each independently impacted multiple neurobehavioral function tests and also interacted with each other to significantly influence the timing and magnitude of changes in memory function. ApoE4 significantly impacted the toxicity of radiation in a sex-dependent manner. Neuropathologic analyses including amyloid beta plaque deposition and ApoE levels are ongoing.

CONCLUSIONS

After brain irradiation of relatively moderate dose, neurobehavioral performance including memory are impacted in a genotype and sex-dependent manner and dynamically over time. In addition to suggesting important sex-dependent differences in memory vulnerability, these data point to new opportunities for personalizing care for patients receiving brain irradiation.
NCMP-08. PRE-OPERATIVE AND INTRA-OPERATIVE RISK FACTORS OF POST-OPERATIVE CEREBELLAR MUTISM SYNDROME IN PEDIATRIC PATIENTS UNDERGOING POSTERIOR FOSSA TUMOR SURGERY: A SYSTEMATIC REVIEW
Authors: Salman Afia , Kumar Kanwal Ashok , Javaid Aaisha , Fahim Muhammad Ahmed Ali , Bashir Hafiza Hifza , Sohail Ayesha , Hussain Nasr , Shamim Muhammad Shahzad
Published: November 2024

INTRODUCTION

Post-operative cerebellar mutism syndrome (pCMS) is a complication of surgical removal of posterior fossa tumors. The neurological and linguistic symptoms of pCMS may resolve in approximately 6 months, however, the children are vulnerable to the burden of significant long-term residual deficits. The current literature lacks a review of intraoperative and preoperative risk factors of postoperative pCMS. The authors addressed this issue by conducting a systematic review of studies investigating these risk factors in pediatric patients with posterior fossa tumors.

METHODS

The authors extracted potential citations from Google Scholar, PubMed, Scopus, and Cochrane. The eligible studies included pediatric patients less than 18 years of age, who were diagnosed with posterior fossa tumors and developed CMS following the posterior fossa tumor surgery.

RESULTS

A total of 64 studies involving 6,420 patients were included in this systematic review. The preoperative risk factors delineated in this review are oncological, tumor location, tumor extension, structural invasion, radiological predictors, preoperative hydrocephalus, age, gender, and pre-operative language impairment. Of these factors, a substantial number of studies reported histopathological diagnosis of medulloblastoma, high-grade tumor histology, and midline location of posterior fossa tumor as significant risk factors of pCMS. The intraoperative risk factors significantly associated with pCMS included vermis incision, superior cerebellar peduncle involvement, medulloblastoma diagnosis, and gross total tumor resection. Only a few studies identified protective factors that reduced the risk of developing pCMS.

CONCLUSION

In this systematic review, we have pooled all the available studies with extractable data to identify the intraoperative and preoperative risk factors of postoperative pCMS in pediatric patients undergoing surgery for posterior fossa tumors. This data can be utilized by healthcare professionals including neurosurgeons in identifying factors that compound the risk of postoperative pCMS and factors that have opposite effects on postoperative outcomes.
NCMP-09. SPONTANEOUS RESOLUTION OF PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML) DEVELOPED AFTER RITUXIMAB TREATMENT FOR LOW-GRADE B-CELL LYMPHOMA
Authors: Alshawa Anas , Latta Shadi , Dixit Karan
Published: November 2024

Progressive multifocal leukoencephalopathy (PML) is a rare viral infection caused by the reactivation of the JC virus, which causes significant morbidity and mortality. Rituximab, a CD20 inhibitor used for B-cell neoplasms as well as autoimmune diseases, is associated with the development of PML. Here, we report a case of a 74-year-old woman with a history of low-grade B-cell lymphoma with biopsy-proven PML with spontaneous immune reconstitution with clinical and radiographic improvement. For her low-grade B-cell lymphoma, she received six cycles of rituximab and bendamustine, followed by one cycle of maintenance rituximab, which was discontinued due to intolerance. Ten months later, she developed progressive left-sided paresthesias, paresis, and incoordination. Brain MRI revealed a large right subcortical frontal-parietal FLAIR hyperintense and peripherally enhancing lesion with leading-edge diffusion restriction. CSF studies revealed elevated protein (385 mg/dL) and negative JCV PCR. A brain biopsy was performed with tissue staining positive for SV40, consistent with PML. Her CD4 count was 88 cells/mm3. A repeat CSF sample one month later showed near normalization CSF protein (47 mg/dL) and negative CSF JCV PCR. MRI of the brain one month later demonstrated complete enhancement resolution and decreased FLAIR abnormality, which correlated with subjective and objective clinical improvement. Her serum CD4 also increased to 134 cells/mm3. This highlights a rare case of PML related to rituximab with spontaneous improvement, which may help guide clinicians in counseling patients who may also develop this complication. Furthermore, this supports the biological rationale for continued investigation of T-cell therapies to achieve immune reconstitution.
NCMP-11. FACTORS INFLUENCING MANAGEMENT STRATEGY AND CLINICAL OUTCOMES IN LOW-GRADE IDH-MUTANT ASTROCYTOMA: A 10-YEAR INSTITUTIONAL CASE SERIES
Authors: Golub Danielle , Shah Harshal A , Mishra Akash , Lynch Daniel G , Modi Siddhi , Garrel Shimon , Ronnen Rebecca , Unadkat Prashin , Sreenivasan Sanjeev , Goenka Anuj , Dehdashti Amir R , Eichberg Daniel G , Gruber Deborah , Li Jian Y , Ziemba Yonah , Schulder Michael , Singer Samuel
Published: November 2024

BACKGROUND

Low-grade IDH-mutant astrocytomas are rare primary brain tumors that typically affect young adults and slowly progress to more aggressive lesions when untreated. Since lengthy follow-up is required to identify high-risk subgroups and useful therapeutic strategies, consensus recommendations after maximal safe resection are still based on low-level evidence and remain unclear.

METHODS

Retrospective chart review of all adult patients with a pathological diagnosis of low-grade (grade 2) IDH-mutant astrocytoma from 2013–2023 at a multi-site tertiary care center was performed. Cases without confirmatory IDH-mutation testing or at least 6-month follow-up imaging were excluded.

RESULTS

A total of 32 patients were included with a mean age of 35.6 years (range: 18–69) and 15 (46.9%) females. Mean follow-up was 40.3 months (range: 8.1–120.7). Preoperative average maximal tumor diameter was 4.1cm (range: 1.4–7cm) with 18 (56.3%) cases involving eloquent cortex. Gross total resection (GTR) was achieved in 12 (37.5%) cases. Observation was the most prevalent postoperative management strategy (n=21, 65.6%), followed by temozolomide-based chemoradiation (n=5, 15.6%), temozolomide alone (n=2, 6.3%), PCV (n=2, 6.3%), radiation alone (n=1, 3.1%), and carboplatin (n=1, 3.1%). Progression of disease (POD) was eventually seen in 17 (53.1%) cases with a median progression-free survival (PFS) of 41.9 months. While GTR was protective against POD (OR:0.14, p=0.019*), initial postoperative management with adjuvant chemotherapy and/or radiation was not (OR:1.09, p=0.907). Additionally, seizures during the follow-up period were significantly associated with POD and a reduced PFS (median 32.5 versus 71.7 months, HR:3.88, p=0.013*). There were no differences in EOR or tumor localization between patients who did and did not have seizures during follow-up.

CONCLUSIONS

Although limited by sample size, this 10-year series confirms the importance of maximizing EOR for low-grade IDH-mutant astrocytoma and suggests that seizures during follow-up can identify high-risk cases that may benefit from more aggressive treatment.
NCMP-18. A CASE OF METASTATIC GLIOBLASTOMA MULTIFORME
Authors: Boldig Catherine , Pina Yolanda , Etame Arnold
Published: November 2024

Glioblastoma multiforme (GBM) is the most common primary brain tumor and rarely causes metastasis. We present a case of a 43-year-old female who developed tingling and heaviness in her right lower extremity in March 2023. This sensation progressed to involve her entire right hemi-body over the next two months. She presented to the emergency department where an MRI show a large left frontal parietal mass measuring 5.2x3.7x3.7cm with significant mass effect. She underwent surgical resection and surgical pathology showed IDH1-mutant R132H, retained ATRX, MGMT promoter mutation, and ki-67 of 80%. She received 6 weeks chemoradiation and then started maintenance temozolomide at 150mg/m2. Temozolomide was increased to 200mg/m2 for cycle 3 maintenance. In March 2024, she presented to the hospital with pain radiating down her legs and saddle anesthesia. MRI lumbar spine showed infiltrating osseous mass at S1 and S2 and bilateral sacral ala with anterior and posterior extraosseous invasion, invading the spinal canal resulting in moderate to severe spinal canal narrowing and compression of the sacral nerve roots. She underwent biopsy of the lesion which showed IDH wildtype metastatic GBM. She also underwent lumbar puncture and cerebrospinal fluid cytology was negative. She experienced pancytopenia limiting chemotherapy options. In April 2024, she underwent PET scan which showed hypermetabolic epidural soft tissue in spinal canal at L5-S1 level, widespread hypermetabolic skeletal lesions, tiny left cervical level 4 lymph node, small hypermetabolic right hilar, aortocaval, left retroperitoneal nodes and a tiny left common iliac node. The incidence of extracranial metastasis is 0.4-2.0% with less than 25 reported cases of bone marrow spread. This is thought to be rare due to the absence of lymphatics within the brain and the limited survival associated with GBM. This metastasis may occur through vascular invasion, perineural spread, lymphatics, direct invasion, or iatrogenic spread into soft tissues.
NCMP-19. IMPACT OF SUBVENTRICULAR ZONE INVASION ON PREOPERATIVE COGNITIVE DECLINE IN DIFFUSE GLIOMA PATIENTS
Authors: Chen Ko-Ting , Li Hsin-Ya , Lao Ian-Hou , Chen Yi-Chun , Wu Yah-Yuan , Chu Yi-Chuan , Wei Kuo-Chen , Chen Pin-Yuan , Chang Wei-Han
Published: November 2024

PURPOSE

To determine the impact of subventricular zone (SVZ) invasion on neurocognitive dysfunction in diffuse glioma patients.

MATERIALS AND METHODS

We collected neuropsychological assessments of treatment-naïve WHO grade 2-4 diffuse glioma patients between 2017 to 2023. The Chi-square test determined the odds ratio (OR), and multiple linear regression identified factors related to cognitive deficits using Python 3.11.4.

RESULTS

Of the 129 patients, 64 exhibited SVZ invasion (SVZ+) while 65 were SVZ-. Groups were matched for WHO grading. SVZ+ was associated with more defective domains than SVZ- in both lower grade (WHO grade 2,3, 3.2 ± 2.1 vs. 2.1 ± 1.9, p=0.019) and high grade (WHO grade 4, 4.9 ± 1.6 vs. 3.6 ± 2.2, p=0.019) tumors. In lower grade gliomas, SVZ+ increased risks of language (OR 7.500, p<0.001) and visual learning impairments (OR 4.375, p=0.014). In high grade gliomas, SVZ+ rendered greater language (OR 8.556, p=0.003) and auditory learning vulnerability (OR 3.850, p=0.039). In right hemispheric tumors, SVZ+ lesions conferred worse executive (OR 6.667, p=0.006) and language function (OR 9.063, p=0.017); in left hemispheric tumors, SVZ+ lesions increased language (OR 3.125, p=0.012) and auditory learning (OR 2.889, p=0.024) impairment. Frontal horn of SVZ+ was related to working memory decline, and body part of SVZ+ was related to emotional deficits. Age and WHO grade 4 were associate with more defective domains in the SVZ+ group. In the SVZ- group, parietal lobe tumor was associate with more defective domains, while high education, temporal lobe, and WHO grade 2 were associate with fewer defective domains.

CONCLUSION

SVZ invasion impacts pre-operative neurocognitive function regardless of lesion laterality and WHO grade. Distinct SVZ sub-regions are linked to specific cognitive impairments. These findings highlight the need for precise tumor mapping involving the SVZ to evaluate neurocognitive outcomes and consider preventive or rehabilitative interventions.
NCMP-23. PATIENTS WITH BRAIN TUMORS HAVE DECREASED BILATERAL FINGER DEXTERITY COMPARED TO HEALTHY ADULTS
Authors: Conway Brian , Taquet Léon , Boerger Timothy , Goetschel Kaitlin , Tarima Sergey , Schmit Brian , Krucoff Max
Published: November 2024

Unilateral brain tumors are known to affect motor control of the contralateral hemibody, but ipsilesional effects are less frequently studied and may be just as impactful to quality of life. Hand dexterity, for example, is a critical skill that often requires both hands. Here, a cohort of 15 patients with unilateral brain tumors and 47 healthy adults performed individual finger movements with each finger (except the thumb) on each hand while tracked by a data glove (Cyberglove III, CyberGlove Systems, San Jose, CA). The ability to move each finger independently was quantified using a scale previously developed by our lab (individuation score) that represents dexterous ability. Repeated-measures two-way ANOVA with factors of group (brain tumor vs. healthy) and laterality (contralesional vs. ipsilesional) were performed for each finger. The lesional side was set to the left brain for cases in the brain tumor group for simplicity of analysis. There was a significant main effect of “group” for all finger individuation scores (index p-value<0.0001, middle p-value<0.0001, ring p-value<0.001, small p-value<0.01) with healthy volunteers scoring higher than patients. There was no main effect of “laterality.” Group-laterality interaction effects were not significant except for the small finger where healthy adults’ right but not left sided individuation scores were greater than the brain tumor group’s (p-value<0.01). Additionally, using cluster analysis incorporating data from both hands, we were able to differentiate patients with brain tumors from healthy adults with 97.9% specificity, 60% sensitivity, 90% positive predictive value, and 88.5% negative predictive value. Ultimately, these results suggest that unilateral brain tumors decrease hand dexterity bilaterally without a significant lateralizing difference except in the small finger. These results suggest unilateral lesions can have bihemispheric network effects, and/or that hand dexterity may rely on ipsilesional connections more than previously understood.
NCMP-26. PATIENTS WITH ANTI-HU/ANNA1 PARANEOPLASTIC NEUROLOGICAL DISORDERS DEVELOP PROGRESSIVE DISABILITY BUT HAVE INCREASED SURVIVAL
Authors: DiMauro Kimberly , Thompson Nicolas , Stevens Glen , Kunchok Amy
Published: November 2024

ANNA-1/Hu-IgG paraneoplastic neurological disorders (PND) are rare and factors associated with disability and survival outcomes are unknown. We aimed to 1) examine disability and survival in ANNA1/Hu-IgG PND and 2) compare survival to a control group of small cell lung cancer (SCLC) without PND.

METHODS

This is a retrospective cohort study of ANNA1/Hu-IgG+ with PND and a control cohort of SCLC without PND (n=1513). Cox proportional hazard models examined clinical predictors of disability and survival. Kaplan-Meier curves examined time to mortality and mRS>2. Cox proportional hazard models compared survival between ANNA1/Hu-IgG PND and SCLC without PND, adjusting for age, sex, cancer stage, and brain metastases.

RESULTS

Forty-five patients with ANNA/Hu1-IgG PND were included (73% female, mean age=63 years [SD=13]). Phenotypes included; neuropathy (16, 36%), ataxia (11, 24%), encephalitis (10, 22%), myasthenic syndromes (3, 7%), myelopathy (2, 4%), enteric neuropathy (2, 4%), myoclonus (1, 2%). Cancers were identified in 78%; SCLC (26, 74%), non-SCLC (4, 11%), other (5, 14%). Immunosuppressive therapy for PND was given in 53%. At 5-year follow-up, 74% had mRS>2. Limbic encephalitis had greater hazard of mRS>2 at last follow-up (HR=7.76, [95% CI=2.20-27.39], p=0.001). At 5-year follow-up, 58% had died. Survival was not influenced by phenotype nor immunosuppressive treatment. Patients with SCLC and ANNA1/Hu-IgG (n=26) were compared to SCLC without PND (n=1513) and had 54% lower hazard of death (adjusted HR =0.46, [95% CI = 0.28–0.76], p=0.003). In ANNA-1/Hu-IgG PND, most patients experienced disability and greater disability was associated with limbic encephalitis, suggesting a potential modifiable factor. However, patients with SCLC and ANNA1/Hu-IgG PND survived longer than patients with SCLC without ANNA1/Hu-IgG PND, suggesting a possible survival advantage due to earlier cancer detection (lead time bias) and/or increased antitumor immunity.
NCMP-30. GLUCOCORTICOID-INDUCED HYPERGLYCEMIA IN BRAIN TUMOR PATIENTS: A SINGLE CENTER RETROSPECTIVE STUDY
Authors: Okoye Obiora , Hurst Katlyn , Corona-Macedo Brayan , Folarin Oluwamuyiwa , Jones Morgan , Kargi Atil , Rauf Yasmeen , Higgins Dominique
Published: November 2024

BACKGROUND

Glucocorticoid (GC) therapies are integral in managing brain tumor-associated cerebral edema and neurological deficits in the neuro-oncology perioperative setting. Despite their effectiveness, GCs can induce significant morbidity, including hyperglycemia.

METHODS

This single-center retrospective study at the University of North Carolina neurological surgery department examines the incidence and risk factors for glucocorticoid-induced hyperglycemia in brain tumor patients treated with high-dose GCs. Data from clinical databases, electronic medical records, laboratory systems, and pathology information banks will be utilized. Documented glucose measurements, glycated hemoglobin test (HbA1c) and clinical outcomes (mortality, infection, hypoglycemia) in brain cancer patients treated with Glucocorticoid (GC) that developed hyperglycemia will be compared with brain tumor patient with normoglycemia.

RESULTS

We will document the total number of brain tumor patients referred over the study period, eligibility rates, and the percentage that developed glucocorticoid-induced diabetes (defined as two glucose measurements ≥200 mg/dL within the first week of treatment). Timing of hyperglycemia onset, treatments received, and risk factors for developing glucocorticoid-induced diabetes will also be analyzed.

CONCLUSIONS

The findings could underscore the necessity for proactive screening for glucocorticoid-induced diabetes in brain tumor patients to mitigate the associated morbidity. This study may guide future research on the benefits of optimized glucose control on clinical outcomes in patients with GC-induced hyperglycemia. Keywords: brain tumor, steroid-induced hyperglycemia, glucocorticoid-induced diabetes, dysglycemia, risk factors, outcomes.
NCOG-02. ASSESSING THE INFLUENCE OF ADJUVANT INTERSTITIAL BRACHYTHERAPY ON MALIGNANT BRAIN TUMOR PATIENTS: INSIGHTS FROM THE NATIONAL READMISSION DATABASE
Authors: Sun Kevin , Zhu Ping , Do Truong , Chen Clark
Published: November 2024

Interstitial brachytherapy (IB) is a form of surgically administered radiotherapy involving the implant of radioactive seeds into the resection cavity after tumor excision. Advances in IB for brain cancers have revived interest in this treatment platform. However, the impact of this therapy on hospital quality measures remains poorly characterized. Here we utilized the National Readmission Database (NRD) to address this gap in knowledge. We identified patients with malignant brain tumors who had undergone either craniotomies (C) for tumor resection or craniotomies augmented with adjuvant interstitial brachytherapy (C+IB) in the National Readmission Database (NRD, 2010-2018). Propensity-score weighting and survey regression techniques were used for analysis. Over the study period, the number of craniotomies with adjuvant interstitial C+IB steadily decreased. For brain metastasis (BM) patients, C+IB and C patients exhibited comparable length of hospital stay (IRR:0.95, CI95:0.61-1.50, p=0.838) and routine discharge to home or self-care (OR:1.01, CI95:0.86-1.18, p=0.918). However, primary brain tumor (PBT) patients who underwent C+IB showed longer hospital stay (IRR:1.43, CI95:1.03-1.99, p=0.032) and are less likely to undergo routine discharge (OR: 0.38, CI95:0.20-0.74, p=0.005) relative to the C cohort. Despite these differences, C+IB and C patients showed comparable 30- or 90- day readmission risk. The profile of readmission diagnoses was also similar. Cost-analysis suggests that IB increased the median total charge by $19,184 (p=0.003). Our analysis suggests that adjuvant interstitial brachytherapy did not alter hospital course/readmission risk for brain metastasis patients. However, PBT patients who underwent this therapy showed longer hospitalization and increased likelihood for non-routine discharge.
NCOG-06. FACTORS ASSOCIATED WITH SOCIAL DISABILITY IN THE CHRONIC POSTOPERATIVE PERIOD IN PATIENTS WITH GLIOMAS
Authors: Nakajima Riho , Kinoshita Masashi , Okita Hirokazu , Nakada Mitsutoshi
Published: November 2024

BACKGROUND

Patients with low-grade gliomas may have no obvious problems during hospitalization or their initial return to social life; however, social life difficulties may gradually become more apparent long after the surgery. We investigated factors associated with social disabilities in patients with low-grade gliomas in the postoperative chronic phase.

METHODS

The study included 114 patients with WHO grade 2 or 3 gliomas who underwent surgery (mean age, 44.3±13.2 years). Seventy-six patients underwent an initial surgery and 38 underwent a second surgery. All patients underwent various brain functional assessments and interviews about their social lives over 1 year after the surgery (median, 23 months). Factors associated with social disabilities were determined using logistic multiple regression analysis and chi-square tests. Voxel-based lesion symptom mapping was used to examine the brain regions associated with social disabilities.

RESULTS

Social disabilities were observed in 12.3% of the patients. Factors associated with social disabilities were the number of surgeries (first vs. second, p=0.0052) and tumor location (left vs. right, p=0.0091). Patients with recurrence and right cerebral hemispheric lesions had a higher probability of social disability (42.1%, p<0.0001) than that of other patients. The reasons for social disability after right hemispheric recurrence were social behavior disorder (62.5%) and neuropsychological dysfunctions (37.5%). Social behavioral disorders include interpersonal problems, such as job switching owing to problems with others, poor interpersonal relationships, and sexually deviant behavior. No other apparent neuropsychological abnormalities were found in patients with social behavior disorders. Surgical resection of the deep part of the right prefrontal area is associated with social behavior disorders and right supplementary motor cortex resection is associated with neuropsychological disorders.

CONCLUSION

In lower grade glioma, patients with right hemispheric recurrence were more likely to develop social disabilities in the chronic phase, which was caused by social behavioral disorders and neuropsychological dysfunctions.