bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-06. GUILLAIN BARRE MIMICKING LEPTOMENINGEAL SPREAD IN CANCER PATIENTS: REPORT OF TWO CASES AN REVIEW OF LITERATURE
Authors: Benouaich-Amiel Alexandra , Yariv Orly , Goldvaser Hadar , Khasminsky Vadim , Cogan Elena , Siegal Tali , Yust-Katz And Shlomit 
Published: December 2020

Abstract

BACKGROUND
Guillain-Barre syndrome (GBS) is an immune acute polyradiculoneuropathy usually presented as an ascending peripheral paresis with absent tendon reflex and albumino-cytologic dissociation on cerebrospinal fluid (CSF) exam.We describe two oncologic patients with GBS who presented with atypical symptoms.

RESULTS
The first patient was a 35 years old woman with newly diagnosed grade 3 invasive breast ductal carcinoma. During the sixth courses of neo-adjuvant chemotherapy she complained at back pain and within 24 hours developed progressive severe bilateral proximal paraparesis with a D10 sensory level. Spine MRI demonstrated diffuse leptomeningeal enhancement. Since leptomeningeal spread (LMD) is uncommon at this stage of breast cancer CSF was obtained. CSF sample revealed albumin-cytologic dissociation (4 cells, protein level 340 mg/dl). EMG showed acute demyelinating neuropathy consistent with GBS. Intravenous immunoglobulins (IVIG) therapy was initiated with clinical improvement. The second patient was a 45 years old woman with newly diagnosed T-Cell lymphoma. Before initiating chemotherapy she presented with a rapidly progressive tetraparesis, hyperreflexia and cervical sensory level. Spine MRI was intact. CSF showed 22 cells without atypia, FACS negative, protein level was 74 mg/dl. The patient worsened clinically. A second CSF sample was obtained and demonstrated an albumin-cytologic dissociation (8 cells without atypia, protein level 115 mg/dl) raising the possibility of GBS. EMG showed acute axonal polyneuropathy consistent with AMSAN variant of GBS. The patient was treated with IVIG with partial recovery.

CONCLUSION
Atypical presentation of GBS could be challenging among oncologic patients and could lead to misdiagnosis and delay in treatment.
NIMG-10. A RETROSPECTIVE ANALYSIS OF SURVIVAL FOLLOWING TREATMENT WITH BEVACIZUMAB IN GLIOBLASTOMA PATIENTS WITH RADIOGRAPHICALLY-CONFIRMED SUBEPENDYMAL OR LEPTOMENINGEAL SPREAD OF DISEASE
Authors: Farooq Shama , Yildirim Onur , Young Robert , Tisnado Jamie , Miller Alexandra 
Published: December 2020

Abstract

OBJECTIVE
We performed a retrospective analysis examining subependymal disease (SED) and leptomeningeal disease (LMD) in bevacizumab treated IDH-wildtype glioblastoma (GBM) patients to assess potential differences in survival.

BACKGROUND
GBMs are highly infiltrative and often invade the subependymal and leptomeningeal space making them challenging to treat. At recurrence, patients are commonly treated with bevacizumab, which leads to decreased tumor size and swelling. Patients have improved PFS, but there is no benefit in OS. This may reflect infiltrative disease progression--a hallmark of late-stage disease. We hypothesized patients with CSF spread manifested by SED and LMD may have worse outcomes after bevacizumab than patients with non-disseminated disease.

METHODS
We retrospectively reviewed charts of all IDH-wildtype GBM patients who received bevacizumab in 2016. MRI scans were reviewed by experienced neuro-radiologists to characterize patients into radiographically defined groups (“0” = no LMD/no SED; “1”= no SED/LMD contact; “2”= no SED/LMD dissemination, and “3’= LMD present). Survival from initiation of bevacizumab to death for each group was compared to group “0” (with no SED/LMD). Survival outcomes were analyzed via t-tests.

RESULTS
We evaluated 87 IDH-WT GBM patients. Radiographically, patients were grouped-- “0”= 16 (18%), “1”= 33 (38%), “2”= 20 (23%), and “3”= 18 (21%). There was no difference between group “0” and any radiographically defined subgroups. Median survival for group “0”= 187 days; group “1”= 219 days; group “2”= 217 days; group “3”= 169 days.

CONCLUSION
Contrary to our hypothesis, there was no significant difference in survival from the initiation of bevacizumab in patients with SED or LMD. This may be related to the fact that these patients also typically have a high burden of parenchymal disease. Further work is necessary to test this hypothesis in a larger cohort.
NIMG-18. THE CLINICAL SIGNIFICANCE OF 13N-NH3, 18F-DOPA, AND 18F-FDG PET/CT IN THE DIFFERENTIAL DIAGNOSIS BETWEEN GLIOMA RECURRENCE AND TREATMENT EFFECTS
Authors: Li Cong , Yi Chang , Chen Yingshen , Xi Shaoyan , Guo Cheng-Cheng , Zhang Xiangsong , Chen Zhongping 
Published: December 2020

Abstract

BACKGROUND
Glioma often recurs and the imaging evaluation whether the tumor has returned after glioma treatment is still challenging. PET/CT is one of the most important techniques to assess the post-treatment of glioma. However, differentiating tumor recurrence (TuR) from treatment effects (TrE) remains difficult. In this study, we aim to retrospectively compare the diagnostic performance of three PET tracers 13N-NH3, 18F-DOPA, and 18F-FDG on PET/CT in differentiating between TuR and TrE in post-treatment glioma patients.

METHODS
Forty-three patients with MRI-suspected recurrent glioma were included. The maximum and mean standardized uptake value (SUVmax and SUVmean) of the lesion and the lesion-to-normal Gray-matter cortex uptake (L/G) ratio were recorded and the reference standard was verified by surgical histopathology or more than 6 months of follow-up with clinical/radiological. The diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis.

RESULTS
34 patients were confirmed as glioma TuR and 9 patients met the standard of TrE. The median time interval from primary diagnosis surgery to PET/CT was 14.83 months (range, 4.10-62.77 months). The SUVmax of 13N-NH3 and 18F-DOPA PET/CT at the lesions was significantly higher than normal brain tissue (13N-NH3 0.696±0.095 vs 0.486±0.071, 18F-DOPA 0.455±0.079 vs 0.194±0.031, both P&lt; 0.001), while 18F-FDG was not (6.918±0.525 vs 6.356±0.510, P=0.290). TuR showed significantly higher L/G ratios than TrE both in 13N-NH3 and 18F-DOPA PET/CT (13N-NH3, 1.573±0.099 vs 1.025±0.128, P=0.008; 18F-DOPA, 2.729±0.131 vs 1.514±0.141, P&lt; 0.001). The sensitivity, specificity and the area under the curve (AUC) by ROC analysis were 57.7, 100% and 0.803 for 13N-NH3, and 84.6, 100% and 0.938 for 18F-DOPA respectively.

CONCLUSIONS
PET/CT is a powerful tool to distinguish glioma TuR from TrE, and 18F-DOPA PET/CT has remarkably better differential diagnosis efficacy than 13N-NH3 and 18F-FDG.
NIMG-19. USING FUNCTIONAL ULTRASOUND (FUS) TO MAP BRAIN FUNCTIONALITY AND TUMOR VASCULATURE WITH MICROMETER-MILLISECOND PRECISION
Authors: Soloukey Sadaf , Vincent Arnaud J P E , Satoer Djaina D , Mastik Frits , Smits Marion , Dirven Clemens M F , Strydis Christos , van der Steen Antonius F W , Bosch Johannes G , De Zeeuw Chris I , Koekkoek Sebastiaan K E , Kruizinga Pieter 
Published: December 2020

Abstract

OBJECTIVE
In the early 20th century, Dr. Cushing first demonstrated the use of electrical stimulation mapping (ESM) to define motor and sensory cortices during neurosurgical procedures. Essentially, little has changed in what guides a neurosurgeon’s intra-operative decision-making since. Inherent limitations of ESM such as limited depth penetration and risk of seizure elicitation, warrant the development of new image-guided resection tools. Here, we present functional Ultrasound (fUS)-imaging as a new, high-resolution tool to guide intra-operative decision-making during awake tumor removal.

METHODS
fUS relies on high-frame-rate ultrasound, which offers images at thousands of frames-per-second. As such, fUS is sensitive to very small motions caused by vascular dynamics (µDoppler), allowing measurements of changes in cerebral blood volume (CBV). This facilitates the possibility to 1) detect functional response, as CBV-changes reflect changes in metabolism of activated neurons through neurovascular coupling and 2) visualize high-resolution vascular morphology of tumor and healthy tissue. During conventional awake craniotomy surgery, n= 10 patients were asked to perform 60s functional tasks to elicit cortical responses. Simultaneously, a conventional 5 MHz ultrasound probe connected to an experimental acquisition system, was placed over ESM-defined functional areas. After image acquisition, correlation analyses with the corresponding tasks revealed functional and non-functional areas. In addition, 3D vascular maps were reconstructed from subsequent 2D-Power Doppler Images (PDIs).

RESULTS
fUS was able to detect functional areas as activated using conventional motor tasks, as well as complex language-related tasks. In addition, both 2D-PDIs and 3D-reconstructions revealed the ability of fUS to detect unique high-resolution onco-vascular characteristics in high- and low-grade malignancies. In all cases, images were acquired with micrometer-millisecond (300 µm, 1.5-2.0 msec) precision at imaging depths &gt; 5 cm.

CONCLUSIONS
Applying fUS-imaging successfully in this awake craniotomy series serves as a clear demonstration of the technique’s revolutionary potential for maximizing safe tumor removal.
NIMG-24. GLYCINE AND GLUTAMINE BY MR SPECTROSCOPY ARE IMAGING BIOMARKERS OF GLIOMA AGGRESSIVENESS
Authors: Choi Changho , Askari Pegah , Daoud Elena , Hatanpaa Kimmo , Raisanen Jack , Lewis Cheryl , Levy Michael , Patel Toral , Pan Edward , Mickey Bruce , Maher Elizabeth 
Published: December 2020

Abstract
Cancers reprogram their metabolism and the resulting alterations in metabolite concentrations may be closely related to the clinical behavior of the tumors. We evaluated glycine, glutamine and 2-hydroxyglutarate (2HG) in 16 adult subjects with glioblastomas (9 male and 7 female; age 43-64 years, median 58) noninvasively using proton magnetic resonance spectroscopy and examined their association with the cell proliferation rate (MIB-1 labeling index) and overall survival. MRS was acquired using point-resolved spectroscopy (PRESS TE 97ms) at 3T. Metabolite levels were quantified with reference to water. The concentrations of glycine and glutamine were both positively correlated with MIB-1 (p=.002 and .0008 respectively). The sum of glycine and glutamine levels showed stronger association with MIB-1 (p&lt; .0001). In the Kaplan-Meier overall survival analysis, the median survival was significantly shorter in patients with glycine levels higher than 2.3 mM than those with concentrations less than 2.3 mM. For glutamine, the patients with higher than 5.7 mM showed association with poor survival. The log-rank p value was substantially smaller in glutamine compared to glycine (p=.008 vs .04). The sum of glycine and glutamine levels showed stronger association with overall survival. 2HG level greater than 1 mM was associated with long survival, which was as expected since elevation of 2HG represents IDH mutant tumors and IDH mutation carries favorable prognosis. Given the association of low 2HG with poor survival, we tested metabolic ratios to 2HG, in which 2HG estimates &lt; 1 mM were put as 1 mM. The glycine/2HG, glutamine/2HG, and (glycine+glutamine)/2HG showed stronger association with overall survival, compared to glycine, glutamine, and glycine+glutamine. Our data suggested that increased metabolism of glycine and glutamine is closely associated with rapid cell proliferation and poor clinical outcome, suggesting the metabolites as an MRS imaging biomarker of glioma aggressiveness.
NIMG-29. DEVELOPING AUTOMATIC SEGMENTATION METHOD FOR BRAIN TUMOR MR IMAGES THAT CAN BE USED AT MULTIPLE FACILITIES
Authors: Takahashi Satoshi , Takahashi Masamichi , Kinoshita Manabu , Miyake Mototaka , Kawaguchi Risa , Shinojima Naoki , Mukasa Akitake , Saito Kuniaki , Nagane Motoo , Otani Ryohei , Ueki Keisuke , Tanaka Shota , Hata Nobuhiro , Nishikawa Ryo , Arita Hideyuki , Nonaka Masahiro , Tamura Kaoru , Tateishi Kensuke , Uda Takehiro , Fukai Junya , Okita Yoshiko , Tsuyuguchi Naohiro , Kanemura Yonehiro , Kobayashi Kazuma , Sese Jun , Ichimura Kouichi , Narita Yoshitaka , Hamamoto Ryuji 
Published: December 2020

Abstract

BACKGROUND
Manual segmentation of brain tumor images from a large volume of MR images generated in clinical routines is difficult and time-consuming. Hence, it is imperative to develop a machine learning model for automated segmentation of brain tumor images.

PURPOSE
Machine learning models for automated MR image segmentation of gliomas may be useful. However, the image differences among facilities cause performance degradation and impede successful automatic segmentation. In this study, we proposed a method to solve this issue.

METHODS
We used the data from the Multimodal Brain Tumor Image Segmentation Benchmark (BraTS) and the Japanese cohort (JC) datasets collected from 10 facilities. Three models for tumor segmentation were developed. The BraTS model was trained on the BraTS dataset, and the JC model was trained on the JC dataset; whereas, the Fine-tuning model was a fine-tuned BraTS model using the JC dataset.

RESULTS
MR images of 544 patients were obtained for the JC dataset. Half of the JC dataset was used for independent testing. The Dice coefficient score of the JC model for the JC dataset was 0.779± 0.137, whereas that of the BraTS model was remarkably lower (0.717 ± 0.207). The mean of the Fine-tuning models for the JC dataset was 0.769 ± 0.138. There was a significant difference between the BraTS and JC models (P &lt; 0.0001) and the BraTS and Fine-tuning models (P = 0.002); however, no significant difference was observed between the JC and Fine-tuning models (P = 0.673).

CONCLUSIONS
Application of the BraTS model to heterogeneous datasets can significantly reduce its performance; however, fine-tuning can solve this issue. Since our fine-tuning method only requires less than 20 cases, this methodology is particularly useful for a facility where there are a few glioma cases.
NIMG-30. PET IMAGING OF ANDROGEN RECEPTOR EXPRESSION IN PATIENTS WITH GBM USING [18F]-FDHT
Authors: Mordechai Anat , Shamni Ofer , Zalcman Nomi , Moscovici Samuel , Chicheportiche Alexandre , Shoshan Yigal , Shahar Tal , Charbit Hanna , Guterman Mijal , Paldor Iddo , Mishani Eyal , Lossos Alexander , Orevi Marina , Lavon Iris 
Published: December 2020

Abstract

BACKGROUND
GBM is associated with poor overall survival partly due to lack of effective treatment. Recently we showed that androgen receptor (AR) protein is overexpressed in 56% of GBM specimens and that AR antagonists induced dose-dependent death in several glioblastoma cell lines. Treatment of mice implanted with human GBM with AR antagonists significantly reduced the growth of the tumor and prolonged the lifespan of the mice. 18f-fluorine-radiolabeled Dihidrotestosteron (DHT), a natural ligand of AR, [16β-18F-fluoro-5α-dihydrotestosterone ([18F]-FDHT)] is one of the PET tracers used to detect AR expression in metastatic prostate cancer. The aim of this study was to identify AR-expressing GBM tumors in real time using PET-CT scan with [18F]-FDHT.

MATERIALS AND METHODS
Twelve patients with GBM underwent a dynamic (first 30 min) and whole body static (later 60-80 min) [18F]-FDHT PET/CT (296-370 MBq) scans 2-4 days prior to the surgery or biopsy. Protein was extracted from the tumor and subjected to western blot analysis. AR Protein fold change of each tumor sample was calculated by densitometry analysis compared with that of normal brain, following normalization to GAPDH.

RESULTS
At ~60 min after injection, 6 of the 12 patients showed significantly higher tumor accumulation of [18F]-FDHT, compared to reference tissue (SUV/Control)mean: 1.33-2.63 fold, (SUV/control)max: 1.4-3.43 fold. The patient who had higher tumor accumulation of [18F]-FDHT, demonstrated also high (1.6-2.27 fold/normal brain) AR protein expression within the tumor. Pearson-correlation-coefficient analysis for the (SUV/Control)mean at ~60 min after the injection versus AR protein expression, was positive and significant (R=0.841;p=0.0024).

CONCLUSION
This study demonstrated for the first time that [18F]-FDHT PET can identify AR-positive-GBM-tumors (with sensitivity and specificity at 100%) and may therefore be a powerful tool to select patients eligible for treatment with AR antagonists. It could possibly be employed also to monitor treatment response and/or progression during the course of therapy.
NIMG-32. THE PREDICTIVE CAPACITY OF PRE-OPERATIVE IMAGING ANALYSIS IN DIFFUSE GLIOMA: A COMPARISON OF CONNECTOMICS, RADIOMICS, AND CLINICAL PREDICTIVE MODELS
Authors: Harrison Rebecca , Tan Bryce Wei Quan , Tan Hong Qi , Tan Lloyd , Lim Mei Chin , Yong Clement , Kuo John , Kesler Shelli 
Published: December 2020

Abstract

BACKGROUND
Radiomics and connectome analysis are distinct and non-invasive methods of deriving biologic information from MRI. Radiomics analyzes features intrinsic to the tumor, and connectomics incorporates data regarding the tumor and surrounding neural circuitry. In this study we used both techniques to predict glioma survival.

METHODS
We retrospectively identified 305 adult patients with histopathologically confirmed WHO grade II–IV gliomas who had presurgical, 3D, T1-weighted brain MRI. Available clinical variables included tumor lobe, hemisphere, multifocal nature grade, histology extent of surgical resection, patient age gender. For connectomics, we calculated nodal efficiencies, network size and degree for all pairs of 33 voxel cubes spanning the entire gray matter volume using similarity-based extraction and graph theory. Radiomic features were extracted using Pyradiomics and subjected to patient-level and population-level clustering (N=172). These clusters were then used to construct a multi-regional spatial interaction matrix for model building. Cox proportional hazards models were fit for clinical variables alone, connectomics alone, radiomics alone, connectomics+clinical and radiomics+clinical. We implemented 10-folds cross-validation and examined the mean area under the curve (AUC) across validation loops.

RESULTS
Median survival time was 134.2 months. The mean AUC for the clinical model was 0.79 +/- 0.01, the connectome model was 0.88 +/- 0.01, the combined connectome + clinical model was 0.93 +/- 0.01, the radiomic model was 0.64 +/- 0.05 and the radiomics+clinical model was 0.89+/-0.03. Radiomic analysis of the entire dataset as well as comparisons of radiomic+connectomics +/- clinical models are pending.

CONCLUSIONS
The combination of clinical variables and connectome analysis provided a more robust predictive model than other models. This suggests that connectome analysis incorporates valuable clinically-predictive information which can augment our capacity for prognostication of patients with diffuse glioma. These methods warrant further evaluation in larger prospective study of patients with diffuse glioma.
NIMG-41. VARIATION IN PERFUSION AND PERMEABILITY MRI DEPENDING ON VASCULAR INPUT FUNCTION SELECTION
Authors: Abbasian Parandoush , Ryner Lawrence , Shankar Jai , Essig Marco , Pitz Marshall 
Published: December 2020

Abstract

BACKGROUND
According to the updated RANO criteria, MRI contrast enhancement and peritumoral edema during the initial 12 weeks within the radiation field following chemoradiation may be pseudoprogression (PP) or true progression (TP). This ambiguity results in diagnostic uncertainty and delays in effective therapies. MRI perfusion and permeability imaging markers, including relative blood volume (rBV), and volume transfer constant (Ktrans), may be useful in differentiating PP from TP. Both techniques rely on identification of a vascular input function (VIF) to produce reliable output maps.

METHODS
Perfusion and permeability maps were acquired from 7 patients on a Siemens 3T Verio MRI as part of an ongoing prospective study on glioblastoma multiforme. Patients received standard surgical resection with concurrent chemo-radiotherapy treatment and MRI follow-up at one and every 2 months. Maps were based on the follow-up MRI. The 3D contrast enhancing lesion (CEL) was segmented from the T1-Post-Gd MRI. VIF pixels were identified in the internal carotid artery (ICA), the M2 segment of the middle cerebral artery (MCA2), the superior sagittal sinus (SSS), automatically using software (Olea Sphere 3.0.22), and auto-edited (removed pixels from the auto VIF definition that were outside the brain).

RESULTS
For the different VIF pixel selections (ICA, MCA2, SSS, Auto, Auto-edited), mean Ktrans values from CEL were 0.32, 0.48, 0.05, 0.09, 0.08, respectively, showing a 10-fold variation. Mean rBV values from CEL were 2.70, 2.36, N/A, 3.10, 3.19, respectively, showing a 1.3-fold variation.

CONCLUSIONS
VIF pixel selection is a critical step in generating reliable perfusion and permeability MRI maps. Variation of up to a factor of 10 in the Ktrans values, depending on VIF selection, was observed. SSS for the permeability VIF resulted in maps that most closely matched literature values, whereas perfusion imaging showed less sensitivity to VIF selection.
NIMG-42. HOROS SOFTWARE FOR POSTOPERATIVE ANALYSIS OF PEDIATRIC HIGH-GRADE GLIOMAS
Authors: Elsawaf Yasmeen , Anetsberger Stephanie , Aguilar-Bonilla Ana , Smith Amy , Elbabaa Samer 
Published: December 2020

Abstract

INTRODUCTION
Horos (LGPL 3.0) is a free, open source medical image viewer that has gained attention in the neurosurgical community because of the familiar OsiriX-based interface and its useful three-dimensional (3D) volumetric rendering capabilities. We present the use of Horos software as a postoperative tool for residual tumor volume analysis in children with high-grade gliomas.

METHODS
A retrospective study of 11 pediatric patients with histologically confirmed HGG underwent tumor resection (n=8) or biopsy (n=3) as definitive treatment from 6/2011 to 6/2019. Volumetric data and extent of resection were obtained via region of interest-based 3D analysis using Horos image-processing software. Age, initial tumor volume, extent of resection, and postoperative residual volume were assessed as predictors of overall survival or event free survival.

TECHNIQUE
Region of interest (ROI) segmentation was performed utilizing the “Closed Polygon Tool” to outline the tumor and the “Generate Missing ROIs” function to capture the entirety of the tumor within the MRI series. The “Computer Volume” function was used to render the 3D tumor volumes. The preoperative and postoperative tumor volumes were compared per patient to yield the percent extent of resection and residual volume.

RESULTS
The Horos software is a highly effective means of volumetric analysis for high-grade gliomas depicted in T1 and T2 MRI series. In our series, eight (73%) patients underwent tumor resection and three (27%) underwent biopsy. Patients who underwent resection were older than biopsy patients [12 (8-18) vs. 9 (8-21) years old]. Age, initial tumor volume, extent of resection, and postoperative residual volume were not significant predictors of overall survival or event free survival.

CONCLUSION
Horos software provides increased accuracy and confidence in determining post-operative volume and is useful in assessing the impact of residual volume on outcome after maximal safe resection in pediatric patients with high-grade gliomas.